Return of Service Bursary

Applicant Information

Name*

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Education

What is the name of the post-secondary institution you are attending, or planning on attending?*

What is the name of the program you are enrolled in?*

What is the length of the program (in years)?*

How many years have you completed?*

Please tell us why you believe you should receive this bursary:*

File Upload

Drop files here or

Max. file size: 100 MB, Max. files: 2.

Attach additional pages as needed.

Have you received any other bursaries or supplementary financial assistance?

Yes

No

Please list the names of each additional bursary/funding programs you have applied to and the amount in which they were approved:*

Documentation

Copy of Government Identification which includes your home address:*

Max. file size: 100 MB.

Two (2) Professional References:*

Drop files here or

Max. file size: 100 MB, Max. files: 2.

Including 2 Executive Officer Signatures

And one of the following:

Acceptance Letter, Enrollment Confirmation, Tuition Receipt, etc.*

Max. file size: 100 MB.

Agreement

I hereby declare that the information I have provided in this application form is, to the best of my knowledge, correct and complete. I acknowledge that this information may be used to determine my eligibility, and to determine whether I must repay any such bursary if I do not complete my program of study, or if I otherwise breach the signed Return of Service agreement.

Declaration*

Date

Agreement*

I have read and agree to the terms above.

The personal information on the form is being collected for the purpose of processing the Return of Service Bursary Application under the Authority of the Freedom of Information and Protection of Privacy (FOIP) Act and is protected by the FOIP. If you have any questions about the collection and/or retention of this information, contact the Big Lakes County FOIP Assistant at 780-523-5955

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