Kin Canada Bursaries Application Form

APPLICATION FORM
Kinsmen, Kinettes and Kin Clubs – Serving the Community’s Greatest Need

Kin Canada Bursaries was established in 1994 by Kin Canada as a legacy to its Founder, Harold Allin Rogers, O.C., O.B.E. (1899-1994) and is funded by Kinsmen and Kinettes across Canada. The program was established to promote, encourage and sponsor educational programs and activities, by providing financial assistance in the amount of $1000 to successful applicants in their quest for higher learning at a recognized post-secondary institution.

To be eligible you must:
1. Be a Canadian citizen or permanent resident.
2. Plan to register as a full-time student in the 2025-2026 school year at a recognized post-secondary institution (e.g. University, College, Trade School, Technical Institute)
3. Demonstrate high ideals, community involvement and knowledge of Kin, and
4. Not have previously received a Kin Canada Bursary.
APPLICATION PROCEDURE: Complete all sections of the current application form and submit by FEBRUARY 1ST via this online application. Applications will not be eligible if emailed or mailed directly to a Club, Kin Canada, or if submitted more than once. If you have questions about the application, visit www.kincanada.ca, call 1-800-PICK KIN (742-5546) or email bursary@kincanada.ca.

To find the Club closest to you when selecting from the drop-down menu, you may visit www.kincanada.ca/find-a-club.

NOTES:
The responsibility for the completed application form rests with the applicant; be sure to answer ALL questions.
- Any information provided may be subject to authentication.
- All information on the application form will be held in the strictest confidence.
- Successful applicants will be notified of the Board of Trustees decision in June. This decision will be final.
- Bursary recipients will be required to submit proof of citizenship (Government-issued ID such as Canadian birth certificate, passport, certificate of citizenship, certificate of Indian Status, Health Card, Provincial Photo Card, or Permanent Resident Card) and proof of registration prior to funds being released.
Select your State/Province:*
Select your Club:*
Alberta (AB)
Select your Club:*
British Columbia (BC)
Select your Club:*
Manitoba (MB)
Select your Club:*
New Brunswick (NB)
Select your Club:*
Newfoundland and Labrador (NL)
Select your Club:*
Nova Scotia (NS)
Select your Club:*
Ontario (ON)
Select your Club:*
Prince Edward Island (PE)
Select your Club:*
Quebec (QC)
Select your Club:*
Saskatchewan (SK)
PERSONAL INFORMATION
Name*

FIRST NAMEMIDDLE NAMELAST NAME
Permanent Address:*

Street Address Line 2

City or TownProvince

Postal Code
Phone Number:*
Please enter a valid phone number.
Applicant E-mail Address:*
example@example.com
Parent/Guardian Email Address:
example@example.com
Date of birth:*

MonthDayYear
Date
Preferred Language:*

EnglishFrench
Eligibility Requirements*

Canadian CitizenPermanent ResidentI plan to register as a full-time student in the 2025-2026 school year at a recognized post-secondary institution.I demonstrate high ideals, community involvement and knowledge of Kin.I have not have previously received a Kin Canada Bursary.
Please select any that apply:*

Out of School for 4+ yearsIn the Work field for 2+ yearsHave DependentsMy field of study is musicMy field of study is businessNot applicable
I understand that if I choose not to answer a question, the points I will receive will be 0 for that section*

Yes, I understand
PROPOSED PROGRAM OF STUDY
Name of Institution:*
Location:*
(City, Province)
Expected Starting Date:*

MonthDayYear
Expected Graduation Date :*

MonthDayYear
Which year of post-secondary study will you be entering in September 2025?*
(1st, 2nd, etc.)
Certificate / Diploma / Degree Expected:*
Program/Area of Study:*
Full-Time or Part Time:*

Full-timePart-time
Why are you choosing this program/area of study?*
EDUCATIONAL HISTORY
Most recent school or institution:*
Grade / Program:*
Finish Date:*

MonthDayYear
Certificate / Diploma/ Degree Completed:*
FINANCIAL INFORMATION

All fields MUST BE COMPLETED or the application will NOT be considered (max. 38 points)
Applicant/Student Net Income for last tax year ($):*
Applicant/Student Net Worth ($):*
1a) Net Income and Net Worth Combined:
1a) Net Income and Net Worth Combined - Points:
What are your estimated expenses of Tuition/Incidental Fees ($) for the upcoming academic year (12 months):*
What are your estimated expenses of Books/Supplies ($) for the upcoming academic year (12 months):*
2a) Cost of Education - School Expenses:
2a) Cost of Education - School Expenses - Points:
What are your estimated expenses of Housing/Accommodation ($) for the upcoming academic year (12 months):*
What are your estimated expenses of Transportation ($) for the upcoming academic year (12 months):*
2b) Cost of Education - Living Expenses:
2b) Cost of Education - Living Expenses - Points:
Have you been out of high school 4 or more years?*

YesNo
Have you been in the work force FULL TIME for 2 consecutive years?*

YesNo
Parents or Guardians Combined Net Income for last tax year:*

Up to $49,999$50,000 – $69,999$70,000 – $89,999$90,000 – $109,999$110,000 and upI choose not to disclose (if you select this you will receive 0 points)
Parents or Guardians Combined Current Net Worth:*

$0 - $99,000$100,000 – $199,000$200,000 – $299,000$300,000 – $399,000$400,000 – $499,000$500,000 or moreI choose not to disclose(if you select this you will receive 0 points)
Parents Combined Net Income for last tax year - Points:
Parents Combined Current Net Worth - Points:
Notes:
- Net Income as reported to Revenue Canada (Line 15000)
- Net Worth = total value of assets (cash, houses, vehicles, investments, RESP, etc.) LESS total value of liabilities (mortgage, loans, etc.). This must be a numerical value.
- Applicants that select “I choose not to disclose” will be awarded 0 points for the question
Number of Parents/Guardians:*
Number of Dependents living at home (including you):*

0123 or more
Dependents living at home (including you) - Points:
Number of children in post-secondary school in 2024/2025:
Do you have children?*

YesNo
How many children?

0123 or more
How many children - Points:
Are you married (or living common-law) ?*

YesNo
Spouse’s Net Income:

up to $49,999$50,000 – $69,999$70,000 – $89,999$90,000 – $109,999$110,000 and upI choose not to disclose
Spouse’s Current Net Worth:

$0 - $99,000$100,000 – $199,000$200,000 – $299,000$300,000 – $399,000$400,000 – $499,000$500,000 or moreI choose not to disclose
Spouse’s Net Income - Points:
Spouse’s Current Net Worth - Points:
ADDITIONAL FINANCIAL CONSIDERATIONS

(max. 15 points)
Are there financial challenges you face of which the selection committee should be aware (i.e. medical condition/extenuating family circumstances requiring additional finances, changes to income, single parent, living accommodations, transportation etc.)?*

YesNo
Please share details of financial challenges.
NON-FINANCIAL CONSIDERATIONS
Are there any non-financial challenges you face of which the selection committee should be aware, if any, you have had to overcome or face in your pursuit of academic, extracurricular or community service goals (ex. community barriers, mental health, other health issues)?*

YesNo
Please share details of non-financial challenges.
List school/community/organization activities that you have been involved in for the past three (3) years (teams, clubs, positions of responsibility, volunteer work, etc.) Describe your role, the number of years involved, and how many hours per year.

For each additional activity, click the plus to add additional lines as required. (max. 12 points)
List any employment positions that you have held in for the past three (3) years (part-time-less than 30 hours/ week, full-time 30+ hours/ week, seasonal, permanent full-time) Please be specific.

Click the plus to add additional lines as required. (max. 5 points)
How do your personal values align with the values of Kin Canada? (max 5 points)*
KIN KNOWLEDGE:

Before you answer these questions, please research and document below what you learned from your research. A personal interview with a current Kin member is recommended. You can find information about your closest Kinsmen, Kinette or Kin Club at www.kincanada.ca.
Who is your closest Kin Canada Club and how has the local Club impacted their community? (max 5 points)*
Describe your experience with Kinsmen / Kinette/ Kin or Kin Campus Clubs:*
Are you a Kin Member?*

YesNo
List any relationships with Kinsmen and/or Kinettes (past or present):*
Additional Points may be added based on Overall Impression of Application. Please use this space to share how this bursary would impact your education and add any additional information related to this application that you feel is important for consideration by the committee.
(max. 10 points)
Would you like to receive a one-time information package about Kin Canada, including information about the benefits of being a part of Kin?*

YesNo
PRIVACY STATEMENT AND APPLICATION AGREEMENT
Personal information under the control of Kin Canada (further known as the Association) and the Hal Rogers Endowment Fund shall remain confidential and shall not, without the consent of the individual to whom it relates, be used by the Association except: (a) for the purpose for which the information was obtained or compiled by the Association; or (b) for a use consistent with that purpose.

By completing and authorizing this Application, you consent to the use of your personal information for: (a) processing of the application;

(b) publication of name in the Association’s Website and Brochure; (c) publication of name in the media/social media; and/or (d) promotional purposes. You also consent to the use of your email address by the association, for the purpose of communication.
Acknowledgement:*

I hereby certify that all information is accurate and can be verified upon request, can prove Canadian citizenship; and that I have not been a recipient of this bursary previously.
I hereby acknowledge and agree to the above privacy statements and use of my personal information by the Association.
Print Name:*
Date:

MonthDayYear
Signature of Applicant:*

Clear
Is applicant age of majority:*

YesNo
Signature of Guardian if applicant not age of majority:

Clear
Print Name:
NOTE: By clicking submit, your application will be directed to the club you selected at the beginning of your application. You will hear about the status of your application in June.
Questions about the application: Visit www.kincanada.ca, call 1-800-PICK KIN (742-5546) or email bursary@kincanada.ca.
Should be Empty:

APPLICATION FORM

PERSONAL INFORMATION

PROPOSED PROGRAM OF STUDY

EDUCATIONAL HISTORY

FINANCIAL INFORMATION

ADDITIONAL FINANCIAL CONSIDERATIONS

NON-FINANCIAL CONSIDERATIONS

KIN KNOWLEDGE:

PRIVACY STATEMENT AND APPLICATION AGREEMENT

I hereby acknowledge and agree to the above privacy statements and use of my personal information by the Association.