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Post-Secondary Educational Assistance PROTECTED WHEN COMPLETED
*Please Print Clearly*
Date of Application: Student Months used:
Full-Time: [ ] Part-Time: [ ] Academic Year:
Spring: [ ] Summer: [ ] Fall: [ ] Winter: [ ] Student ID. Number:
Institution:
Address:
Personal Information:
| 1. NAME: | 2. PARENT'S NAMES: |
3. STUDENT ADDRESS:
Telephone: | PERMANENT ADDRESS:
Telephone: |
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| 4. TREATY NO.: | 5. BILL C-31: Yes [ ] No [ ] |
| 6. MALE [ ] FEMALE [ ] | 7. DATE OF BIRTH: |
| 8. SINGLE [ ] MARRIED [ ] | EMPLOYED [ ] UNEMPLOYED [ ] |
9. NUMBER OF DEPENDENTS(S) (Register with Kahkewistahaw Band)
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10. PLEASE LIST YOUR DEPENDENT CHILDREN IF APPLICABLE:
| NAME | REGISTRY NO. & D.O.B. | SCHOOL ATTENDING |
| | | |
| | | |
| | | |
| | | |
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| 11. NEXT OF KIN: TELEPHONE: |
12. PREVIOUS EDUCATION AND TRAINING:
12. PLEASE OFFER INFORMATION REGARDING YOUR ELEMENTARY AND SECONDARY SCHOOLING AND, AS WELL, ANY POST-SECONDARY TRAINING/EDUCATION YOU MAY HAVE UNDERTAKEN.
| SCHOOL NAME | LOCATION | YEAR COMPLETED | PROGRAM COMPLETED | CERTIFICATE/ DEGREE |
| ELEMENTARY | |
| SECONDARY | |
| POST SECONDARY | |
| PRESENT EDUCATION GOALS | |
13. NAME/ADDRESS OF POST-SECONDARY INSTITUTION YOU WISH TO ATTEND:
COURSE/PROGRAM:
YEAR: PREP [ ] 1 [ ] 1 [ ] 3 [ ] 4 [ ] GRAD [ ]
FUNDING PERIOD: START DATE: END DATE:
14. DO ONLY IF YOU ARE A FIRST YEAR STUDENT OR IF YOUR GOALS HAVE CHANGED SINCE YOUR LAST APPLICATION. BRIEFLY DESCRIBE BOTH YOUR SHORT-TERM AND LONG-TERM EDUCATIONAL GOALS. INDICATE CLEARLY THE IMPORTANCE OF THE COURSE/PROGRAM YOU WISH TO ATTEND. USE SEPARATE PAPER AND ATTACH TO FORM. PLEASE WRITE NEATLY AND CLEARLY.
CONTRACT BETWEEN
KAHKEWISTAHAW FIRST NATION POST-SECONDARY PROGRAM
AND THE STUDENT
I understand the following conditions for sponsorship by the Kahkewistahaw First Nation Post-secondary studies:
- I will accept the responsibility to adhere to the school regulations and meet the standards required.
- I agree to attend classes regularly and to maintain twelve (12) credit hours each and every semester. If I can not maintain twelve credits I will contact the Post-Secondary Counsellor immediately.
- I agree to consult with the Counsellor if any problems arise academically, emotionally, physically and financially.
- I agree to provide my marks and reports on a semester-by-semester basis to the Kahkewistahaw First Nation Post-secondary Program and/or upon request.
- I agree to report any changes to my student and/or program status promptly. I understand that it is a serious matter to provide false information and/or fail to report any change in the information provided.
- I authorize the Kahkewistahaw First Nation Post-secondary Education program to obtain information from persons, agencies, or organizations to determine and/or verify my eligibility for benefits or services under the Post-Secondary Student Education Program.
- I declare that all of the information provided is true and complete and I make this solemn declaration believing it to be true and knowing that it is of the same force and effect as if made under oath.
- I understand that I have the right to appeal any decision made with respect to my application for sponsorship.
- Dependents must reside in your residence in order to claim them as dependents.
I HEREBY AGREE TO THE TERMS/CONDITIONS FOR FINANCIAL ASSISTANCE THAT I HAVE READ ABOVE.
STUDENT SIGNATURE |
DATE |
PRINT NAME |
STUDENT NUMBER |
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