Application Information
Section A: Applicant Information
First name:
Last name:
Date of birth:
Current school:
Home address:
City:
Postal code:
Phone number(h) (c):
E-mail address:
Years involved in the Pete Petersen Basketball League :
Section B: Leadership and Volunteerism
List the community service or school activities in which you have participated. Please attach or Enclose additional pages as required.
Name of organization or school initiative:
Years of involvement (from - to)
Time commitment (e.g. monthly/weekly/hours)
Is this a credited school course?
Yes No Did you receive pay, a wage or financial benefit for this activity?
Yes No
Explain the type of activities involved:
Name of organization or school initiative:
Years of involvement (from - to)
Time commitment (e.g. monthly/weekly/hours)
Is this a credited school course?
Yes No Did you receive pay, a wage or financial benefit for this activity?
Yes No
Explain the type of activities involved):
Section C:
Volunteer Work and Community Service Summary
Summarize all of your community service volunteer work; please tell us about your experiences.
Please be sure to include:
• How and why you became involved with the organization or school initiative;
• Why you felt it was important;
• What sort of impact or contribution you made to your community;
• What impact the community service had on you
Section D:
Applicants Outlook
• The basketball league's motto is "Just for the Fun of it" what would your motto be?
• How has your involvement with the Pete Petersen Basketball League influenced your outlook on Life?
Candidate's Declaration
By submitting this application by email/mail, I declare and agree that all information that I have provided in my application is true, complete and accurate to the best of my knowledge.
I understand and agree that:
• My application information may be subject to verification.
• Application materials will not be returned.
Publication of Applicant Information
I agree to the publication of the name, secondary school, city/town, brief list of scholastic/athletic achievements, photograph and anticipated university/college and course of study of all successful applicants, in publications, websites, newsletters, and press releases to selected Canadian media outlets.
Students Name : ________________ Date: ________