Graduate Award for Black and Indigenous Students Application Form

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Graduate Award for Black and Indigenous Students Application Form

Use this form to apply for the Graduate Award for Black and Indigenous Students. Applicants will be notified of the decision by the Graduate Student Association as soon as a decision has been made.

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Section 1: Student information

University of Waterloo student identification number*

Name*

First name Last name

Email*

Faculty*

(e.g. Arts)

Department or School*

(e.g. History)

Is Fall 2023 your first term in the PhD program?*

Yes

Current term at time of application*

(e.g. Spring 2023)

Overall average of current or most recently completed program*

Do you self-identify as Black?*

Yes

For the purpose of this award, according to the University’s Equity Data Strategy, Black students may include those of African, Caribbean, Black Canadian, Afro-Latine, African American, or other African descent.

Do you self-identify as Indigenous?*

Yes

For the purpose of this award, an Indigenous person is one who is a citizen or member of a First Nations (Status/Non-Status), Métis, Inuit community as defined in the Canadian Constitution Act 1982.

Section 2: Student checklist

Describe how you identify, and the ways in which your identity has contributed to your personal and academic growth.*

300 words max

Describe any academic or non-academic extracurricular, volunteer, leadership or entrepreneurial-related experiences that you have been involved in within the last 3 years. Please describe any past and current achievements in your community and/or other communities you support. Feel free to include on-campus and/or off campus experiences and academic or non-academic experiences and indicate the specific activities, your role and the significance of your experience.*

300 words max

Please share what personal and professional goals you are hoping to achieve upon obtaining your doctoral degree.*

150 words max

Describe how receiving this award to support your graduate studies would impact you.*

200 words max

Describe any career interruptions or personal challenges (e.g., racism, trauma, loss, socioeconomic constraints, etc.) that might have affected your academic performance or hindered your ability to attain non-academic extracurricular, volunteer, leadership or entrepreneurial-related experiences? (optional)

200 words max

Provide a copy of your Curriculum Vitae*

Max. file size: 16 MB.

Provide a signed reference letter (in PDF format) written by an academic or non-academic referee who can speak to your experiences, values, and work in the communities that you are part of and/or communities you support.*

Max. file size: 16 MB.

Because you answered in a previous question that you identify as Indigenous, please provide documentation confirming Indigenous identity. Examples of acceptable documentation include Status card, Band membership card, citizenship card issued by a Métis National Council governing member or the Manitoba Métis Foundation, land claim beneficiary card, a letter from an Indigenous organization or community, an affidavit which explains why you claim Indigenous citizenship/membership without documentation.*

Max. file size: 16 MB.

To protect the integrity of Indigenous candidates, applicants are required to provide documentation confirming their Indigenous identity. This supporting documentation will be verified by the Office of Indigenous Relations at the University of Waterloo.

Section 3: Applicant’s disclosure statement and signature

Applicant Signature*

Please write down your full name

Date*

Please write down the date when you are submitting this form

Last Updated: April 24, 2023

Graduate Student Association - University of Waterloo

Labour office hours

Wellness Support

Please contact gsa-wellness@uwaterloo.ca if you are a graduate student in need of support.

President's Office Hours

By Appointment only.
Please contact the GSA office if you wish to book an appointment

Location

SLC 3222
University of Waterloo
200 University Avenue West
Waterloo, ON N2L 3G1

Territorial Acknowledgement

We acknowledge that we work on the traditional territory of ‎ the Attawandaron (Neutral), Anishinaabeg and Haudenosaunee peoples. The University of Waterloo is situated on the Haldimand Tract, the land promised to the Six Nations that includes ten kilometers on each side of the Grand River. We acknowledge that we work on these territories as beneficiaries of settler colonialism. We also acknowledge that members of our UWaterloo community live on Indigenous territories around the world.

This statement is only a small step in the process of reconciliation. Decolonization requires systemic change. The GSA-UW is committed to this effort.

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