Application for Post-Secondary Assistance

Application For Post-Secondary Education Assistance

Part 1: Student Information

First Name

Middle Name

Last Name

Current Address

Address Line 1

Address Line 2

City

Province

Postal Code

Marital Status

Single

Married

Common Law

Date of Birth

Next of Kin (Emergency Contact) Name:

Next of Kin Address

Address Line 1

City

Province

Postal Code

Part 2: Family Status

List Dependents, their age and if they are residing with you:

Child Name 1

Age

Residing with you?

Yes

Comments

Child Name 2

Age

Residing with you?

Yes

Comments

Child Name 3

Age

Residing with you?

Yes

Comments

Child Name 4

Age

Residing with you?

Yes

Comments

Child Name 5

Age

Residing with you?

Yes

Comments

Child Name 6

Age

Residing with you?

Yes

Comments

Part 3: Previous Education & Training

I am applying for assistance for funding to enroll at a post-secondary program/s at which I have been accepted. The details are as follows:

Continuing Student?

Yes

New/First Time Applicant?

Yes

Has Previously Applied for Post-Secondary Funding from Lucky Man Cree Nation?

Yes

Was the Course/Program Completed successfully if previously applied for funding?

Yes

If course was not completed please explain why?

Starting Date (for the year):

Completion Date (for the year):

Program/Course of Study:

Attendance

Full Time

Part Time

Institution Acceptance

Yes

Unknown

REMINDER TO APPLICANT: Formal Acceptance Letter/Documentation to the Institution MUST be Attached to this Application. Applications will be sent back if this document is not attached.

I certify that the above information is true and complete and that I am not receiving any other funding for this request. I understand that if I provide false or misleading information in this contract, I will be responsible for repaying tuition, texts and living allowances, and any future application for education funding will be denied.

I understand that if I drop out or am requested to discontinue, I will not be eligible to receive funding from Lucky Man Cree Nation for two academic years.

I understand that I have the right to appeal any decision made with respect to my application for sponsorship.

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.

Please Type Your Name To Confirm Your Acceptance of these Terms

Date of Acceptance of Terms