Bursary Application Bursary Application Form A) Personal InformationApplicant's Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime Phone*Cell Phone*Email* Parish InformationApplicant's Parish*- Select One -All Saints (Coquitlam)Blessed Sacrament (Vancouver)Canadian Martyrs (Richmond)Christ the Redeemer (West Vancouver)Church of the Assumption (Powell River)Corpus Christi (Vancouver)Good Shepherd (Surrey)Guardian Angels (Vancouver)Holy Cross (Burnaby)Holy Cross (Crescent Beach)Holy Family (Sechelt)Holy Family (Vancouver)Holy Name of Jesus (Vancouver)Holy Name of Mary (Bella Coola)Holy Rosary Cathedral (Vancouver)Holy Spirit (New Westminster)Holy Trinity (North Vancouver)Immaculate Conception (Delta)Immaculate Conception (Vancouver)Immaculate Heart of Mary (Vancouver)Our Lady of Fatima (Coquitlam)Our Lady of Fatima (Vancouver)Our Lady of Good Counsel (Surrey)Our Lady of Good Hope (Hope)Our Lady of Hungary (Vancouver)Our Lady of Lourdes (Coquitlam)Our Lady of Lourdes Church (Sechelt)Our Lady of Mercy (Burnaby)Our Lady of Perpetual Help (Vancouver)Our Lady of Sorrows (Vancouver)Our Lady of the Assumption (Port Coquitlam)Precious Blood (Surrey)Sacred Heart (Delta)Sacred Heart (Vancouver)St. Agnes Kim (Coquitlam)St. Andrew (Vancouver)St. Andrew Kim (Surrey)St. Ann (Abbotsford)St. Anthony (West Vancouver)St. Anthony of Padua (Agassiz)St. Anthony of Padua (Vancouver)St. Augustine (Vancouver)St. Bernadette (Surrey)St. Casimir (Vancouver)St. Clare of Assisi (Coquitlam)St. Edmund (North Vancouver)St. Francis de Sales (Burnaby)St. Francis of Assisi (Vancouver)St. Francis Xavier (Vancouver)St. George Melkite-Greek Catholic Mission (Burnaby)St. Gerard Mission (Bowen Island)St. Helen (Burnaby)St. James (Abbotsford)St. John the Apostle (Vancouver)St. Joseph (Garibaldi Highlands)St. Joseph (Langley)St. Joseph (Mission)St. Joseph (Port Moody)St. Joseph (Vancouver)St. Joseph the Worker (Richmond)St. Jude (Vancouver)St. Luke (Maple Ridge)St. Mark (Vancouver)St. Mary (Chilliwack)St. Mary (Gibsons)St. Mary (Vancouver)St. Mary Magdalene (Cheam)St. Matthew (Surrey)St. Michael (Burnaby)St. Monica (Richmond)St. Nicholas (Langley)St. Patrick (Maple Ridge)St. Patrick (Vancouver)St. Paul (North Vancouver)St. Paul (Richmond)St. Paul (Vancouver)St. Peter (New Westminster)St. Pius X (North Vancouver)St. Stephen (North Vancouver)St. Theresa (Burnaby)Star of the Sea (White Rock)Sts. Cyril & Methodius (New Westminster)Sts. Joachim & Ann (Aldergrove)Sts. Peter & Paul (Vancouver)Sts. Peter & Paul Chaldean Catholic Mission (Surrey)Visitation of the Blessed Virgin Mary (Anahim Lake)How did you hear about the Catholic Gap Year bursary? Where are you planning to go for your Catholic Gap Year? ("Organization")*- Select One -Catholic Christian OutreachChrist in the CityEmmanuel School of MissionFamily Missions CompanyJesuit Volunteers CanadaMadonna HouseNET CanadaNET USASt. Therese Institute of Faith and MissionOther:Other (let us know what the program or organization is called) B) Reflection QuestionsReflection Question #1: Why are you interested in a Catholic Gap Year and what do you hope to get out of this experience?*In 300 words or less, describe your motivation to apply for a Catholic Gap Year and consider how this award will help you.Reflection Question #2: How are you currently involved in your community and how will you reconnect with your parish once you are back from your Catholic Gap Year experience?*In 400 words or less, describe your involvement in leadership positions in your parish, school, community, and home. Be sure to include your motivation, your influence, and the nature of your involvement.Reflection Question #3: What does being Catholic mean to you?*In 400 words or less, talk about you faith and what makes you proud to be Catholic. Share examples of how you've been able to display your identity as a young Catholic.As a recipient of the Catholic Gap Year Bursary, I, the Applicant, expressly agree that:* I have selected the organization above as my volunteer placement, and have conducted my own inquiries, inspections, investigations and assessments of this organization I assume any and all risks involved in the selection of this organization as my volunteer placement I understand that the Archdiocese of Vancouver and its staff are not responsible for my choice of organization or volunteer placement, and have made no warranties or representations about that organization or volunteer placement upon which I have placed reliance I understand that the Archdiocese of Vancouver and its staff are excluded from any and all liability or responsibility for any loss, injury or damage arising in connection with this volunteer placement and/or the actions or omissions of this organization C) Budget FormWrite down the cost of how much money you will be putting towards your mission in the categories belowCost of Program*Travel Cost To/From* Miscellaneous Cost D) ReferenceSend the following link to two different references to fill out by the Application Deadline on July 31, 2020: www.catholicgapyear.ca/referenceSubmission of Application* By submitting this application, I understand that the information will be used to assess my eligibility for the scholarship and I hereby certify that the statements contained in my application are true, accurate and complete.