Language
English (US)
POST-SECONDARY STUDENT SUPPORT PROGRAM APPLICATION FORM
Elsipogtog First Nation - Education Authority
APPLICANT INFORMATION
Full Name
*
Date of birth
*
/
Month
/
Day
Year
Band No.
*
Phone
*
Number of Dependents
Name of Dependents
Current Address
*
City
*
Province
*
Postal Code
*
Mailing Address
Fill if "Mailing Address" is not the same as "Current Address."
City
Province
Postal Code
Email
*
example@example.com
INSTITUTION YOU PLAN TO ATTEND
Name of Institution
*
Address
*
City
*
Province
*
Postal Code
*
Phone
*
Student No. (If Known)
Please Check
*
Residence
Rent
Degree Sought
*
Years Completed/Program Length
*
Training Dates: To and From
PLEASE CHECK APPROPRIATE LEVEL
*
Level 1 (UCEPP/Community College)
Level 2 (Undergraduate)
Level 3 (Master's Degree)
Level 4 (Doctorate Degree)
PLEASE CHECK SESSION TIME FRAME
Semester(s) Length
*
Fall & Winter
Spring
Summer
Course Load
*
Full-Time
Part-Time
PREVIOUS EDUCATION (HIGH SCHOOL/POST-SECONDARY)
Atleast 1 required
Name of Institution
*
Years Attended
*
Name of Institution
Years Attended
Name of Institution
Years Attended
Name of Institution
Yeats Attended
ESTIMATED COSTS
Books
Living Allowance
Materials & Supplies
Student Fees
Travel
Tuition
Total
EDUCATION PLAN/CAREER GOALS & OBJECTIVES
*
TERMS AND CONDITIONS
By signing this Application Form, you agree to the following statements:A LETTER OF ACCEPTANCE FROM THE INSTITUTION AND/OR A COPY OF OFFICIAL TRANSCRIPTS MUST BE SUBMITTED BEFORE YOUR APPLICATION CAN BE CONSIDERED.I, THE UNDERSIGNER, DO HEREBY ACCPET THE RESPONSIBILITY OF STAISFYING THE ACADEMIC OR TRAINING REQUIREMENTS OF THE ABOVE-NAMED INSTITUTION AND OF MANAGING THE EDUCATION ASSISTANCE FUNDS IN A MANNER WHICH IS BOTH REASONABLE AND RESPONSIBLE.I AUTHORIZE THE ABOVE-NAMED INSTITUTION TO RELEASE TO THE ELSIPOGTOG FIRST NATION EDUCATION AUTHORITY SUCH PERTENANT INFORMATION FROM MY RECORDS AS THEY MAY REQUIRE FROM TIME-TO-TIME.
Signature of Applicant
*
Clear
Date
*
/
Month
/
Day
Year
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