Qualtrics Survey | Qualtrics Experience Management

1. Name

2. Contact Email

3. Student Number

4. Indigenous Self Identification

First Nations
Métis
Inuit
Comment:

5. Program of study and year:

6. Statement of Intent:

Please copy and paste your a letter of intent (400 words maximum) in the text box below. In the letter please be sure to include the following prompts:

Please introduce yourself, your Indigenous community or background and why you have applied for the award.
Be sure to self-identify based on individual award criteria (see descriptions above).
Describe your work, personal, and/or volunteer experience with Indigenous peoples and communities.
Describe your program of study, how it will assist you in achieving your education and career goals and your interest in improving the health of Indigenous peoples. Please self- identify based on the specific award criteria you are applying to.

7. Academics:
Attach a screenshot copy of your most recently completed semester of grades (24 credits)

8. Letters of Reference:
Attach two letters of reference (one academic, one professional/community)

Reference letter 1 upload:

Reference letter 2 upload:

9. Consent:
I hereby declare that the information included in this application is, to the best of my knowledge, correct and complete. I understand that UBC retains the right to verify information on my application.

I consent

If I am the recipient of the award, I understand that by signing this declaration on this date, I authorize UBC to: release to Award Adjudication Committee members the information provided in this application form; prepare a brief biographical profile to be used for award presentation ceremonies and receptions; release to award donors my name, year and program of study, and other information relevant to the requirements of the award, for the purpose of maintaining donor relations and informing donors about the outcomes of their gifts.

I consent