Print the application form and take your time in answering the questions as thoroughly and accurately as possible. When you have finished answering the questions, you can either scan the application form and email it to Soroptimist International of Victoria Westshore (lyd@sivw.ca) or you can use the form as a reference guide to filling out the online application form below.

NOTE: The online application form does not save and must be completed in one sitting.

Part I. Basic Information

First name*

Last name*

Address (Number and Street Address)*

City / Province*

Postal Code*

Phone*

Email*

Date of Birth:*

Marital Status:*

Highest level of education achieved*

Date Completed*

Number of dependents you support (NOT including yourself)*

How are they related to you (children, spouse, parents, etc.)?*

Ages (if they are children)*

Part II. What are your education and career goals?

A. What's the name of the school or training program you are attending or have been accepted to?*

B. What are you studying? (example: Bachelor of Science, Nursing Degree or Computer Science Certificate*

C. When will you complete your studies (month and year)?*

D. Are you working while you are getting your education? (check one)*

Yes

If yes, how many hours per week?

E. In 300 words or less, please tell us about your career goals, and give specifics about how your education and training supports these goals.*

Part III. Financial Information

Live Your Dream Award recipients are chosen in part based on financial need. Please share information about your annual income and expenses. Please be as exact as you can.

A. INCOME: Please list your ANNUAL household income and savings (from the money you have left after taxes) in the chart below.

Employment - $ amount per year*

Government Assistance - $ amount per year*

Savings - $ amount per year*

Loans - $ amount per year*

Child Support - $ amount per year*

Scholarships - $ amount per year*

Alimony - $ amount per year*

Please list any additional income, including income other household members receive.

Source

$ amount per year

Source

$ amount per year

Source

$ amount per year

Total Annual Income*

B. EXPENSES: Please list your ANNUAL household expenses in the chart below.

Housing - $ amount per year*

Utilities - $ amount per year*

Food - $ amount per year*

Medical - $ amount per year*

Childcare - $ amount per year*

Transportation - $ amount per year*

Tuition - $ amount per year*

Books - $ amount per year*

Please list any additional expenses.

Expense:

$ amount per year

Expense:

$ amount per year

Expense:

$ amount per year

Total Annual Expenses*

Part IV. Tell us more about yourself

The Live Your Dream Award is all about helping women who have faced economic and personal hardships to live their dreams. Since 1972, the award has provided tens of thousands of women with cash grants to help them achieve their educational and career goals. The program helps women build a better life for themselves and their dependents. Do you think this award could help you live your dream? In 750 words or less, tell us about the challenges you've faced and how you think this award could help you to live your dream.

Your Story*

Part V. Agreement

Please read the following information carefully. When you type your name below, you are agreeing to what you have read.

o I certify that all the information provided in this application is complete and accurate to the best of my knowledge. I will notify Soroptimist International of Victoria Westshore if there are any changes.
o I certify that this is the only application I have made - in any format or to any address - this year for a Soroptimist Live Your Dream Award.
o I understand that my application may be submitted electronically for evaluation.
o I understand that my application becomes the property of Soroptimist International of the Americas. The application will be considered confidential unless the applicant grants Soroptimist International written permission to release personal information for the purpose of publicizing the award.

By typing your name below, you adhere to the above requirements.

Signature of applicant*

Date*

How did you hear about the Soroptimist Live Your Dream Award

A local Soroptimist club

A friend, relative or co-worker

A career counsellor or advisor at my school

Social Media

A flyer posted in my community

Internet search

Searchable database of scholarships

Other

Thank you for applying for the

Live Your Dream Award

Congratulations on all you have achieved so far!

Soroptimist International of Victoria Westshore

P.O. Box 100

1621 Island Highway

Victoria, BC

V9B 1H8

lyd@sivw.ca

Part I. Basic Information

Part II. What are your education and career goals?

Part III. Financial Information

Part IV. Tell us more about yourself

Part V. Agreement

Thank you for applying for the

Live Your Dream Award

Congratulations on all you have achieved so far!

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