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ARTA - Johnson Award Application FormPERSONAL DATA: Mr./Ms. Home Address:…………………………………………………………………………….. Postal Code:……………………………Telephone ( )………………………………. Marital Status:…………………………………………………………………………….. Date of Birth:………………………………………… ARTA MEMBER'S DATA:…………………………………………………………. RELATIONSHIP TO ARTA MEMBER:………………………………………………... VALIDATION SIGNATURES: By signing this application, you both agree that all the information you have disclosed or provided is accurate and complete to the best of your knowledge at time of signing. APPLICANTS SIGNATURE: …………………………………. DATE: Year ____ Month ____ Day ____ ARTA MEMBER'S SIGNATURE: …………………………………. DATE: Year ____ Month ____ Day ____ EDUCATIONAL DATA: Year High School Completed:…………… Name of High School:……………………….. COMPLEMENTARY EDUCATION. Please list any other formal education or certificates earned since completion of your high school career. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… POST SECONDARY INSTITUTION INFORMATION. Name of institution where you have successfully completed at least one year of a program: ……………………………………………………………………………………………… Name of program: ………………………………………….. Year of program completed: …………………………….. If returning to complete your program please name the Institution where you will be attending and the year of your program.
Address: ………………………………………………………………………………. ……………………………………………………………………………….. City: ……………………..Province……..………… Postal Code:.………….
…………………………………………………………………………………………….. …………………………………………………………………………………………….. …………………………………………………………………………………………….. ……………………………………………………………………………………………... ……………………………………………………………………………………………… WORK EXPERIENCE: Since we do not know you we would like to know some of your work experiences while in high school and since completion of high school. Why you chose these experiences and how they fit in your overall plan for a life career? ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ………………………………………………………………………………………………. YOUR LIFE EXPERIENCE: Here's your chance to "sell yourself". Briefly tell the committee members about any other experiences or especially things you have gleaned from your work experiences or observations of life that made you choose the career you are pursuing. Don't be too modest as many times the letters of reference provided give a glowing picture of you while you may not have recognized the important role you played in your community. Examples may include community leadership, special project(s), volunteer services, outside interests and hobbies as well as extra-curricular participation and successes. If you need more space please attach a typewritten sheet to this application. ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………... ………………………………………………………………………………...
Letters of Reference Please arrange to have TWO letters of reference mailed directly to the Executive Secretary of ARTA before the application deadline. The chosen references should not be directly related to you and should be knowledgeable of your accomplishments, capabilities and deportment. You are encouraged to use the letters of reference form provided with this application package Letter of reference # 1: Name: …………………………………………………………………. Address: ………………………………………………………………. …………………………………………………………………………… …………………………………………………………………………… Phone number: Home: ( ) ………………….… Work: ( ) …………………. Letter of reference # 2: Name: ………………………………………………………………………………. ………………………………………………………………………………… ……………………………………………………………………………….. Phone number: Home: ( ) …………………… Work: ( ) …………………..
Letter # 1 ARTA - Johnson Award Reference APPLICANTS NAME: …………………………………………………………. SUBMITTED BY: …………………………………………………………............... Address ……………………………………………………………………………. ……………………………………………………………......................... Phone Number: Home ( ) ………………………. Work: ( ) ……………………….. 1. How long have you known the applicant and in what capacity? ………………………. ……….…………………………………………………………………………………
…………………………………………………………………………………………. ………………………………………………………………………………………….. …………………………………………………………………………………………. 3. Would you describe what types of behavior the candidate has exhibited during the time you have known her or him. Examples: leadership qualities, communication ability, community involvement, empathy, outstanding achievements, perseverance. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… …………………………………………………………………………………………….. ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… 4. Why do you feel the applicant is worthy of this award? ………………………………. …………………………………………………………………………………………. ………………………………………………………………………………………… ………………………………………………………………………………………… 5. Are there any other factors about the applicant that you feel should be considered by the Selection Committee? ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………..
Date of completion of reference letter: …………………………………………………. Date of mailing reference letter: (if different from above date) …………………........ Please send the above reference to: The Executive Secretary, ARTA
Letter #2 ARTA - Johnson Award Reference APPLICANTS NAME: …………………………………………………… SUBMITTED BY: …………………………………………………………... Address: …………………………………………………………………. ……………………………………………………………........ Phone Number: Home ( ) ………………………. Work: ( ) ……………………….. 1. How long have you known the applicant and in what capacity? ……………………… ……….…………………………………………………………………………………
………………………………………………………………………………………….. …………………………………………………………………………………………. …………………………………………………………………………………………. 3. Would you describe what types of behavior the candidate has exhibited during the time you have known her or him. Examples: leadership qualities, communication ability, community involvement, empathy, outstanding achievements, perseverance. ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ………………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… 4. Why do you feel the applicant is worthy of this award? ………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… 5. Are there any other factors about the applicant that you feel should be considered by the Selection Committee? ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… ………………………………………………………………………………………
Date of completion of reference letter: …………………………………………… Date of mailing reference letter: (if different from above date) …………………... Please send the above reference to: The Executive Secretary, ARTA ARTA © 2004 |