Student Assistance Recipient Information Form

The personal information on this form is collected under the authority of the Royal Charter of 1841, as amended. The information collected will be sent to the designated fund contact(s) but will not be used to update any University records databases.

If you have any questions or concerns about the information collected or how it will be used please contact the Stewardship Office by telephone at (613) 533-2060 or email

Recipient Information
Your e-mail address is for internal Advancement purposes only and will remain confidential
Please include your street and city
Where you are originally from
Numeric value
Personal Statements

For the following, please write your responses in the first person and in complete sentences. Please see examples below.

Example: I am interested in better understanding how humans alter the sustainability of our resources, as well as how we understand our place in the biosphere. As we continue to manage and construct our natural environment, it's important to scope out the full impact of our decisions and to see how we can improve our policies to better the environment.
Example: After my honours degree is finished, I would like to continue on in research biology through a masters and, potentially, a doctorate degree. My dream is to be one of the three biologists on Canada's Species at Risk Act Board. I would love to aid in the preservation of species for future generations.
Example: This award has made for a much less stressful student experience for me. It has allowed me to focus my spare time on extracurricular activities, and not to have to worry about carrying a part time job. This freedom has given me the chance to volunteer in labs and perform in productions, both of which I love to do.
Example: Thank you so much for your donation to my studies. This award has allowed me the freedom to experience as much as I can while I'm at Queen's. I hope that one day I am able to make a similar impact on a student.
Required: Enter the matching characters that appear in the image below. If you cannot use the image, please use the audio options.