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David L. Squires Foundation
C/O ITI International Technology Integration Inc.
3450 #301 Uptown Blvd
Victoria, B.C. V8Z 0B9

David L. Squires Foundation Scholarship Application

Note: Red text indicates required fields
Last Name:     Given Names:    
Address Line 1:     City:    
Address Line 2:   Province:    
Country:     Postal\Zip Code:     
Student Number:      Phone:    
Email Address:  

The Squires Foundation provides scholarships each year to students who:
  • demonstrate significant financial need;
  • are Canadian Citizens OR Landed Immigrants;
  • are in a full time Computer Science program at a University or College;
  • have successfully completed 2 full semesters in this program; and,
  • reached a high level of scholastic achievement.
Short listed applicants will be asked to provide a copy of the following documents to the committee:
  • Proof of Citizenship OR Landed Immigrant Status.
  • Transcript of marks for the two most recent academic semesters completed.
  • Proof of registration in applicable courses.
  • Two personal references.
Note: For transcripts that specify marks as Grade Point Averages, convert to percentage based on what local institution GPA is equivalent to.

A. Academic Program Information:
Note: To qualify for this scholarship you must currently be registered as a full time student AND have successfully completed 2 full semesters in this program;

Institution Name:  
Degree/Program Name:  
Other Computer or IT Program Details:  
Duration of this program (Years):  
Year of program you are currently in:       
Year you expect to graduate:  
What is your grade point average for your last 2 completed semesters/terms expressed as a percentage out of 100?
Semester #1 
Semester #2 

B. Provide 2020 Net Income:

Please provide your 2020 net income from line 236
on your Notice of Assessment form from the Canada Revenue Agency.

C. Employment:
Expected Income: Jan.1 to Dec.31 - Current Year $ 
Are you currently employed? 
Full-time   Part-time   Not-employed

Occupation 1:
Employer 1:
Occupation 2:
Employer 2:
D. Awards and Scholarships:
Have you or will you receive any Awards or Scholarships this calendar year?       Yes   No

If yes, please provide the following information: Jan.1 to Dec.31 Current Year $ 
   Award Name Year Amount
E. Student Loans:
Have you or will you receive any Student Loans this calendar year?       Yes   No

If yes, please enter total: 
Jan.1 to Dec.31 Current Year $
F. Other Sources of Funding (eg. Family):
Source Amount
G. Actual and Anticipated Expenses:
Jan.1 to Dec.31 Current Year $
Tuition Fees:
H. Affirmation:

(Please read carefully)

  I agree to all the terms.

By submitting this form to the committee, you are:

  • confirming that you are a Canadian Citizen OR Landed Immigrant;
  • providing a virtual signature attesting to that all information is true.

Privacy Statement:
All information provided in this application and subsequent enquiries will be used for the sole purpose of determining eligibility for awards.
Information will only be viewed by members of the selection committee and will not be shared with any external bodies or agencies.
Names of winners will be published.