Name: _________________________________________________________

Address: _______________________________________________________

City: _________________      Province: ____________      Postal Code: __________

Telephone: _______________(h)      ________________(w)      Fax: _____________

Email: ___________________________________________________________

Date of Birth ______________     Occupation ______________________________

Years in the British Columbia Boys Choir _______________________________

The main purpose of my request is ___________________________________ ___________________________________________________________________

Cost of the project/school/fees $___________     Amount requested $____________

If reference letters are being sent with this application, please provide their names, occupation and telephone numbers below. These must be in sealed envelopes, with the referee's signature signed across the closed seal.

Name	Occupation	Phone #
1.
2.

* Do not forget to send a one-page written summary, describing in detail, how the funds from a Barney Allen Bursary would be used.

______________________________________		___________________
Applicant's Signature		Date