LICI Launch Grant

Name Name First Last
Student ID
Must be 9 characters. Currently Entered: 3 characters.
You unique Concordia University issued student identification number.
Email
Program
Employer Information
Employer Name
Employer Address / Location
Employer Contact Phone Employer Contact Phone - ### - ### ####
Does your employer provide tuition reimbursement?
How did you hear about this scholarship opportunity?

How did you hear about this scholarship opportunity? Friend or family member Poster, flyer or print material Concordia Website My human resources department or administrator Concordia representative who visited my workplace Was told about it during the application process Was told about it after I’d been accepted by my advisor Searched the internet for "scholarships" Other
Signature

Signature I understand that checking this box constitutes a legal signature confirming the truthfulness of the information provided in this application.