Formulaire de demande de subvention

Name*
First Last
Call Sign*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

This address will be used for mailed correspondence.
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Place of Birth*
If not born in Canada:

If not born in Canada, state: (a) date you became permanent resident (b) date of Canadian citizenship
Date of Canadian Citizenship
MM slash DD slash YYYY
Marital Status*
Academic Level Achieved*
Name and Telephone number of Academic Advisor
Academic Student Number / ID:*
Name and Address of Institution you plan to attend*
Institution must be a Revenue Canada Qualified Donee
Describe your extra-curricular interests
Describe briefly your plans after successfully completing this academic year*
Electronically Submitted to:
Radio Amateurs of Canada - Grants Committee
720 Belfast Rd., Suite 217
Ottawa, ON K1G 0Z5
Name
This field is for validation purposes and should be left unchanged.

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