APPLICANT DECLARATION AND CONSENT (must be signed and witnessed)
CONSENT CLAUSE, DECLARATION AND RELEASE OF INFORMATION
(To be completed by student)
- I consent to and authorize the release of any personal information by my employer, banks or other financial institutions, mercantile organizations, indigenous organizations, educational institutions and by federal, provincial, territorial and municipal government departments and agencies, including the Canada Customs and Revenue Agency to the Gwich’in Tribal Council. My personal information will be used to determine my initial and continued eligibility for funding and for the effective and efficient general administration and enforcement of the GTC Education and Training Programs.
- In addition, I consent to and authorize the release of any personal information by the Gwich’in Tribal Council to any indigenous organizations and/or federal, provincial, territorial and municipal government departments and agencies for the purpose of the effective planning, development, delivery and monitoring of the GTC Education and Training Programs.
- I understand that “personal information” means and includes:
a. my name, home or business addresses and telephone numbers,
b. my national or ethnic origin;
c. my age, sex, marital status or family status, and date of birth,
d. my financial status and history;
e. any identifying numbers, symbol or other particulars assigned to me such as my social insurance number, health care card number, or personal identification number;
f. Information about my educational or employment status and history.
- I understand that the personal information that may be released to banks or other financial institutions, mercantile organizations, Indigenous organizations, government organizations and educational institutions are:
g. my name, home or business addresses or home and business telephone numbers;
h. my national or ethnic origin;
i. my age, sex, marital or family status, date of birth; and
j. my financial status and history.
I agree to provide such additional consent to the release of my personal information as may be required from time to time by the Gwich’in Tribal Council.
DECLARATION
I declare that the information submitted in this form is correct to the best of my knowledge.
I agree to:
• use any funding received from the GTC Education and Training Program funds towards the cost of my education and return any refunds of tuition or other fees and any GTC Education and Training funding that I am not entitled to;
• immediately notify the GTC Education and Training Program staff in writing if I change my status as a full time student in an approved program, my study period, my marital status, the status of my dependants or financial status, any changes to my address(es), phone numbers and bank accounts;
• provide information or documents requested by the GTC Education and Training Program staff to verify any statement made in this application; and
• to follow the terms and conditions of any funding that I may receive.
I understand that:
• I may have to repay my financial assistance now or in the future to the Gwich’in Tribal Council if there are changes to my financial, marital, or dependant status; or my status as a full-time student in an approved program;
• I may be denied financial assistance now and in the future, if:
• I make false or misleading statement in this application;
• I do not comply with a request from the GTC Education and Training Department to provide information or documents so that information in this application may be verified;
• My eligibility for GTC Education and Training Program funds may be effected by income that I, or my spouse, receive from other sources; and
• I have an outstanding debt to the Gwich’in Tribal Council or its affiliates or to other funding agencies.
• The GTC Education and Training Program Staff will contact me periodically to gather statistical information as it relates to my education and training for which I am being sponsored and I agree to fully participate in providing such information.