Warren Grapes Application Form

2007 APPLICATION FORM

Name            _____________________________________________________________

Address *       _____________________________________________________________

                _____________________________________________________________

City            _____________________________   Postal code     _____________

Telephone       Home    _______________________ Work    _____________________

                E-mail  _______________________ Fax     _____________________

* Permanent address in Quebec

Highest level of education completed	_____________________________________


For the 2007/2008 school year, I will be attending the following institution:

Name            _____________________________________________________________

Program         _____________________________      Year      ________________

Please attach a one page summary of why you are pursuing an education in agriculture or silviculture, what you hope to achieve from your education and how you will benefit from receiving a scholarship from the Warren Grapes Agricultural Education Fund. Refer to the criteria listed on the attached information sheet; include any references or recommendations that you believe will support your application.

All applications must be submitted electronically to: qfa@upa.qc.ca

DEADLINE: Friday, October 12, 2007

Good luck!