Brock Leaders Citizenship Society

The Brock Leaders Citizenship Award is awarded to entering secondary school students who have achieved exceptional academic success, outstanding leadership and community involvement.

Applicants should read the BLCS Application Overview thoroughly before completing the application. Any questions may be directed to brockleaders@brocku.ca.

Submitting the Application

Your application and all supporting documents must be uploaded and submitted in the form below no later than April 14th at 4:30 pm EDT.
Brock Leaders Citizenship Society Application Overview

Note: Please make sure you have all materials prior to starting the application below. You cannot save and go back to the application once it is started.

Failure to complete any requirement in the form below will result in the application being void and not considered.

1 Section A: Contact and Education Information

2 Section B: Endorsement Letters

3 Section C: Expectations, Goals, Aspirations

4 Section D: Volunteering, Extracurriculars, and Employment

5 Section E: Essay

6 Section F: Transcript

7 Section G: Declaration and Signature

Description, Application and Selection Process
Description and Selection
Every year 10 to 15 students are inducted into the BLCS by receiving the Brock Leaders Citizenship Society Award. BLCS members will receive an $8,000 ($2,000 per year) award in addition to their Brock Scholars Award. Receiving the BLCS award does not exclude students from consideration for any other award program at Brock.
Brock Leaders Citizenship Society awards selection considers a combination of the following factors:
• Admission average
• Personal leadership activities. For example: extracurricular activities beyond the students’ school requirements and/or significant citizenship contributions to their community.
Application Requirements and Renewal Criteria:
All BLCS applications require:
• 1 full and complete application
• 2 signed letters of reference (1 community reference, 1 school reference)
• 1 official transcript of the most current grades. The transcript must have the school seal. The official transcript should reflect your complete secondary education (grade nine to date)
Conditions of Membership
• Students must register full-time each year at Brock University.
• Students must maintain an 80% average to renew.
• Students must remain in good standing with the Brock Leaders Citizenship Society.
• Visit www.brocku.ca/blcs for a complete list of requirements
Selection Process
A special selection committee will review and select the recipients. Committee decisions are final and reviewed in camera. The deadline for the application is April 14, 2022 at 4:30 pm. All applications must be complete and submitted by the deadline of they will be disqualified.
Successful applicants will be notified by email.
Contact Information
Please fill in the identification tables below:
Name * Required
Citizenship * Required
Phone number * Required
Email * Required
Campus ID * Required
Student number
Date of birth - must be yyyy/mm/dd format * Required
Date Format: YYYY slash MM slash DD
Address * Required
Number / Street City State / Province / Region Country
Education
List all the schools you have attended, starting with the most recent * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Name of school City / Country Board of Education Years attended (YYYY-YYYY)

Endorsement letters
Please include two letters of endorsement for your application. You are to include one reference from your school and one reference from the community.

This person should not be a friend/relative. They will have observed you closely in school or the community and are aware of your various involvements.
School Referee Information
Name * Required
Title * Required
Relationship to applicant * Required
Phone number * Required
Email * Required
Upload School Endorsement Letter * Required
PDF or Word documents only.
Accepted file types: pdf, doc, docx.
Community Referee Information
Name * Required
Title * Required
Relationship to applicant * Required
Phone number * Required
Email * Required
Upload Community Endorsement Letter * Required
PDF or Word documents only.
Accepted file types: pdf, doc, docx.

Expectations, Goals, and Aspirations
What hopes, expectation, and future goals do you have for your post-secondary studies? (Maximum 150 words) * Required

Volunteer and Extracurricular Activities
Use the following headings to list and share your volunteer and extracurricular involvement with your school and the community.
Please indicate if you were an: Initiator (I) / Leader (L) / Participant (P)

The selection committee may request volunteer contact information if necessary.

ONLY INCLUDE RELEVANT EXPERIENCE AND LIST IN ORDER OF IMPORTANCE.
List your extracurricular involvement with your school and in the community * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Activity Brief explanation Date started Date ended Total hours Level of engagement (I / L / P)
List your volunteer contributions with your school and in the community * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Activity Brief explanation Date started Date ended Total hours Level of engagement (I / L / P)
Employment, Recognition and Interests
Employment * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Employer Position / Brief explanation Summer, school year, co-op or full-time Date started Date ended Total hours
Achievements, awards, honours, and trainings * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Award / honour / training Brief explanation Year received
Competitions and conferences attended * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Competition / conference Brief explanation Period of involvement
Hobbies and interests * Required
Please fill in ALL columns and use the + button at the end of each row to add more.
Activity Brief explanation Period of involvement

Essay
“The Brock Leaders Citizenship Society is a group of exceptional students recognized for a combination of high academic achievement and personal leadership abilities. These students, prior to attending Brock University, have demonstrated academic excellence, and have provided significant citizenship contribution to their community. BLCS members continue to achieve academic success while utilizing their past leadership abilities to continue to grow, motivate, organize, inspire and create opportunities for themselves, University and the surrounding community.”
Please write a 1-page essay on the next page which discusses your most significant leadership role and how it contributed to your school and/or the surrounding community, how you would like to contribute to leadership and community at Brock University, and why you aspire to be a member of the Brock Leaders Citizenship Society. (Maximum 500 words) * Required

Official Transcript
Please upload an official transcript of your most current grades. The official transcript must have the school seal and reflect your complete secondary education (grade nine to date).
Official Transcript Upload
Please upload your official transcript of your most recent grades.
Drop files here or

Declaration and Sign-off
How did you hear about this application? * Required
Please specify other * Required
Declaration * Required
I certify that the information provided on this application form and on the accompanying documentation is true, accurate and complete. I have read the eligibility criteria and terms thoroughly with this application I accept to be bound by all of them. I authorize the release of any information held or to be held by secondary schools, post- secondary institutions, community sources and others, relating to my application to the Student Awards Office of Brock University. I understand the information resulting from such a request will be used for the determination of the Brock Leaders Citizenship Society Award only. I also agree to allow my name and information that I provided, as well as, my likeness to be used in publicity, research and/or promotional materials/sources.
I agree to the terms outlined above.
Signature * Required
Phone
This field is for validation purposes and should be left unchanged.

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In this section

Brock Leaders Citizenship Society

The Brock Leaders Citizenship Award is awarded to entering secondary school students who have achieved exceptional academic success, outstanding leadership and community involvement.

Submitting the Application

Description, Application and Selection Process

Contact Information

Education

Endorsement letters

School Referee Information

Community Referee Information

Expectations, Goals, and Aspirations

Volunteer and Extracurricular Activities

Employment, Recognition and Interests

Essay

Official Transcript

Declaration and Sign-off

Helpful links

Connect

Name of school	City / Country	Board of Education	Years attended (YYYY-YYYY)

Activity	Brief explanation	Date started	Date ended	Total hours	Level of engagement (I / L / P)

Employer	Position / Brief explanation	Summer, school year, co-op or full-time	Date started	Date ended	Total hours

Competition / conference	Brief explanation	Period of involvement

Award / honour / training	Brief explanation	Year received