2023 McBurl Employee Scholarship Program

Employee Information

First and Last Name: Gaurav Patel

Home Address: 175 Hunter Street west Hamilton Ontario (L8P 1R4)

Telephone Number: 5197319032

Email Address: gauravpatel7777g@gmail.com

Restaurant: 1505 Guelph Line, Burlington

Role: Crew Member

School Attending in September: Third semester

Program/Field of Study: Software Development

Year (please circle): 3

CERTIFICATION, ACKNOWLEDGEMENT and CONSENT

I certify, to the best of my knowledge, that the information on this application is complete and accurate. Falsification or incompletion
of any information will cause my disqualification from the scholarship competition. I understand that it is my responsibility to make sure that this
application is completed and mailed by the required postmarked deadline, listed on the application. Furthermore, I understand that if my
application is not complete, or if I do not submit my application by the postmarked deadline, I may be disqualified from the scholarship
competition and will not be considered for a scholarship.

The information submitted in support of this application is collected and will be used and disclosed solely for the purpose of, administering and
promoting the scholarship program. The applicant understands and agrees that the information collected may be used and disclosed by
agents engaged by the Company to administer the scholarship program, including, without limitation, evaluating the applications and
verifying eligibility. The applicant further understands and agrees that any information submitted by the applicant becomes the property of the
Company and/or any agent engaged by the Company to administer the scholarship program, and may be disclosed to advertise and promote
the scholarship program. The applicant consents to the use by the Company’s and/or its agents of any information submitted or collected
in connection with this application, including the applicant’s name, photograph, and/or statements made or attributed to him/her
relating to the scholarship program, for advertising and publicity purposes in any medium, without further notice, approval or compensation.

_______________________________________________ _______17-07-2023______________________
Signature of Applicant Date

_______________________________________________ ___________________________________
Signature of Parent/Legal Guardian if applicant is under 18 years of age Date