Last name: 

First name: 

Email address: 

This field is required.

Additional contact information: 

Phone number

SFU student ID:

If you have received your ID, please put it in

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Question 1:

Question 1: Describe why you are interested in your chosen field of study. Please give examples of how you have committed to your chosen field. (300 words)

Answer Question 1: 

Question 2:

Question 2: Describe an accomplishment that demonstrates your ability to make a positive impact on your community. (300 words)

Answer question 2: 

Question 3:

Question 3: This scholarship seeks to support women in computing science. If you are awarded this scholarship, how do you plan to create positive change your chosen field of study? (300 words)

Answer question 3: 

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Reference Contacts:

Please provide two contacts as referees: 1. Academic Reference 2. Community Reference

References cannot be a peer or family member.

Name of Academic Reference: 

First and Last name of Academic Reference

Relationship to Academic Reference: 

What is your relationship to your Academic Reference?

Email address for Academic Reference: 

Name of Community Reference: 

First and Last name of Community Reference

Relationship to Community Reference: 

What is your relationship to your Community Reference?

Email address for Community Reference: 

Freedom of Information and Protection of Privacy:

The information on this form is collected under the authority of the University Act (R.S.B.C. 1996, c.468, s. 27(4)(a)) and is needed to process your application and decide your eligibility for this funding. The Faculty of Applied Sciences at SFU may release designated information to the donor of the award, provincial funding organizations and/or SFU departments and faculties. The names of recipients may also be used for promotional purposes. If you have any questions about the collection, use and disclosure of this information, contact the Associate Director, Academic Affairs, Simon Fraser University, fas_academic_affairs@sfu.ca

Declaration: 

• I agree

I certify that all statements on this application are true and complete to the best of my knowledge. I understand that any misrepresentation/falsification of information will result in cancellation of my application or award. I understand that I may also be required to repay an award, and/or be subject to University disciplinary action. I understand that all information is subject to audit and verification. I will provide supporting documentation upon request for verification of eligibility. By checking the box, I agree to the terms as stated above, and confirm that all information provided in this application is true and correct

This field is required.