T.D. Mayer – Community Living Bursary

This Bursary is established to provide a meaningful level of funding for residents of Bruce and
Grey County who have a developmental / intellectual disability to pursue Post Secondary
Education. With the addition of Inclusive Education programs such as Community Integration
through Co-operative Education Programs at Ontario Colleges, new opportunities are now
available.

Eligible Expenses:
The bursary can be used for any purpose so long as it is related to a post-secondary education
(tuition, books, lodging, computer or other technology etc)

Admission Requirements

The candidate must:

1. Reside in Bruce or Grey County at time of application
2. Have a developmental / intellectual disability
3. Demonstrate a level of personal independence necessary to attend college as a full time student.
4. Prepare and upon request present a letter of application that summarizes their personal profile and articulates their personal goals and interests.
   

Application Process:

Applicants must complete the application outlining their post-secondary goals and providing
proof of application or enrolment in a college or other post-secondary program.

In addition to the application form, applicants must submit an essay or presentation that includes:

• A personal biography
• Details about the post-secondary program they plan to attend
• What they hope to gain from the experience

A panel will review all applicants and select the winner. The selected applicant must provide
the following in order to receive the funds:

• Proof of acceptance into a post-secondary program
• Confirmation of a developmental disability (such as a letter of support from a developmental service provider in Grey or Bruce County)

For more information or you would like an application form, please contact your Family
Resource Worker or your Community Support Worker.

Please send completed form to info@comlivos.on.ca

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Name: Mr./ Miss/ Mrs. *

Last/First/Middle

Date of Birth *

Year/Month/Day

Social Insurance Number *

This is a CRA requirement

Mailing Address: Street Name and Number *

City *

Province *

Postal Code *

Telephone (Home Number) *

Telephone (Alternate Number)

Email Address (optional)

Or

• Send by Mail

Alternate Contact Person ---------------------

• I WOULD PREFER TO BE CONTACTED THROUGH ANOTHER PERSON (ie parent, support person etc.)

Alternate Contact Name (Mr./Mrs./Miss)

Last/First/Middle

# Email Address

Apt. # Street Number and Name

City

Province

Postal Code

Phone Number (Main)

Phone Number (Alternate)

Email Address (optional)

BASIS FOR ADMISSION - Check off all that apply *

• Developmental / Intellectual Disability (confirmation required at phase two)
• Confirmation of application / acceptance to a Post-Secondary Programs

(Note: applicant must meet application criteria in order to be considered)

College Name and Program *

19 years or older on the first day of class *

• Yes
• No

Educational History - From high school, I graduated / will graduate with: *

• Ontario Secondary School Diploma (OSSD)
• Ontario Secondary School Certificate (OSSC)
• Other

please check off all that apply

If you selected other, please specify

Signature and Date - When you sign this application, it means that you are giving the T.D. Mayer – Community Living Bursary Selection Panel permission to talk about you and your application in order to determine who will receive the Bursary. No information in this application will be shared with any person outside of the Selection Panel without your permission or at your request. Note: If you are a successful applicant the amount of the bursary will be reported to Canada Revenue Agency along with your Social Insurance Number. *

I certify that the above information is true and complete. I understand that any false or incomplete information submitted in support of my application may invalidate my application.

Submit

Purpose:

• To recognize and encourage excellence in the field of Developmental Services.
• To recognize and honour Mr. J. Irvine Brown for his efforts to improve the lives of people with
  developmental needs and his dedicated service to Community Living Owen Sound and District.

Eligibility:

1. You must be a graduating secondary school student residing in the Owen Sound
   through to Saugeen Shores area (most commonly this would include students of
   Saugeen DSS, Chesley DSS, OSDSS, St. Mary’s).
   
   Note: if you attend one of these schools but do not live in the area served by
   Community Living Owen Sound and District (Saugeen Shores through to Owen
   Sound and area), please check your local Community Living office regarding
   their award program.
   
2. Nominees must be accepted to enroll in a recognized post-secondary College or University as a full-time student.
   
3. Nominees must be able to demonstrate a commitment to the mission and vision of Community Living Owen Sound and District through their personal, volunteer, co-operative education, or employment experience.

Selection Criteria:
Nominees will be rated based on the following criteria:

1. Students enrolled in a Developmental Services Worker – College Program will be
   given first consideration.
   
2. Students enrolled in a related Social Service College Program or a University Social Science course will be given secondary consideration.
   
3. Demonstration of academic achievement and the students’ involvement in both
   school and community activities, along with their commitment to supporting
   people with developmental needs, will be the final considerations.
   
   In the event that there are two or more equally qualified nominees, the Board of
   Directors will be consulted.
   

Application: Schools will be made aware of the Award opportunity and it will be promoted via
social media. The deadline for submission will be on or about May 15th. The award will be
presented at the Association’s Annual General Meeting in June.

Please send completed form to info@comlivos.on.ca

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Applicant Name *

First

Last

Date of birth *

MM/DD/YYY

Current Address *

Phone Number *

City *

Province *

Postal Code *

School Information: Current/Graduating School *

Year (if School

Graduating Year *

School Address *

City *

Province *

Postal Code *

University or College of Choice: Institution Name *

Phone Number *

Address *

City *

Province *

Postal Code *

Name of Course *

Status *

• Applied
• Accepted

Date accepted (if applicable)

Length of Program *

Reference 1 Name *

Reference 1: Relationship & Contact Details *

Reference 2 Name *

Reference 2: Relationship & Contact Details *

Additional Information: Please submit a short summary of your work and/or volunteer experiences.

Authorization and Signature: I authorize the verification of the information provided on this form as to my credit.

Type name and date

Submit