2025-2026 Bursary Application Form - De Salaberry Health District Centre Foundation

Please fill out the form to apply for the Bursary.

Form also available in French (See top right corner)

De Salaberry Health District Centre Foundation is presenting two bursaries of $1000 for two individuals that are in their last year of their program, in any health related field.

Examples:
Nursing, Medicine, Health Care Aide, Nutrition, X-Ray Technicien, Phlebotomist, Mental Health Service Provider etc...

*Must currenlty reside or have resided in the RM of De Salaberry or Village of St. Pierre Jolys.

*Deadline for submissions is February 28, 2026

Full Name*

First NameLast Name

Email Address*

example@example.com

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Address*

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

If your current address is not in the RM of De Salaberry or Village of St.Pierre-Jolys, what years did you reside in our area?*

*Must currently or previously lived in De Salaberry or the village of St.Pierre-Jolys.

Current School/University*

Estimated date of completion of courses?*

MonthDayYear

Field of Study*

Why do you deserve this scholarship?*

Maximum of 250 Words

Why are small regional hospitals like De Salaberry District Health Centre important?*

Maximum of 250 Words

Bursary Terms of Agreement

Bursary Provider: De Salaberry Health District Centre Foundation
Bursary Amount: $1000
Academic Year/Period: 2025-2026 Academic Year

1. Purpose of Funding
The bursary funds are awarded to the recipient for the sole purpose of covering educational expenses related to the approved program of any health related field.

2. Eligibility and Enrollment
The individual chosen must notify the provider immediately of any changes to their enrollment status or program of study.

3. Payment and Use of Funds
Payments will be made directly to the recipient. Funds must be used for permitted expenses such as tuition, books, equipment, and travel costs. The bursary cannot be used for general household income support.

4. Reporting and Documentation
The recipient agrees to provide official final academic results to the provider to receiving funds. The recipient confirms that all information provided in the application is true and accurate.

5. Breach of Agreement and Repayment
The bursary may be withdrawn, and the recipient may be required to repay all or part of the funds received if they:
Fail to meet the eligibility criteria or academic requirements.
Provide false information or misrepresentation on their application.
Withdraw from their studies without valid reason and prior notification.
Use the bursary for purposes other than the cost of education.

6. Acceptance of Terms
By signing this agreement, the individual confirms they have read, understood, and agree to all the terms and conditions outlined above.

Yes, I agree.No

Name*

First NameLast Name

Date*

MonthDayYear

Signature*

Please verify that you are human*

BURSARY APPLICATION FORM