Name of applicant / Social insurance number / Birth date (Yr/Mth/Day) / Gender
MF
Current address / City / Province / Postal code
Phone number / E-mail address
Name contact person / Relationship / Phone number
Address of contact person / City / Province / Postal code
Please attach supporting evidence of our ancestry or further explanation
Name of Band / Band number
Marital status
SingleSingle parentMarried/Common-law
Number of dependants
Under age 10Under age 18Other
For term of study will your spouse/partner be:
EmployedFull-time studentAt home caring for dependent children
Not applicableOther:
For term of study will you be living with parent/step-parent/sponsor/legal guardian
YesNo
B. Education Information
Last school/university/college attended / Year attended
University/college attending this academic year / Phone number
Name of education coordinator/counselor / Phone number
Program of studies (include anticipated degree, diploma, etc.) / Length of program
(minimum of two years)
Please tick the box to indicate what year of your program you are entering at the time of your application
1 2 3 4 5
Please indicate the start and finish dates of your term(s) for this academic year.
Month: Year: ToMonth: Year:
Courses enrolled in this academic year
C. Expenses(Sections C and D must both be completed)
Monthly living costs / Amount / One-time education costs / Amount
Rent/mortgage/residence
(also include strata fees, taxes, renters, home insurance) / $ / Tuition and required fees for term of study / $
Utilities
(Hydro, gas, water, etc.) / Mandatory books/supplies
Local transportation
(insurance, gas, public transport) / Return transportation
(school/home 2 return trips)
Food / Other (please specify)
Child Care / Total for One-time education costs / $
Other (please specify) / Add total for One-time education costs / $
Total monthly living costs / $ / Total expenses (Section C): / $
D. Income/Financial Resources for Term of Study
List income and source of income. Include all actual or projected income from: band education sponsorship, employment earnings (full-time or part-time, net earnings after payroll deductions) co-op or assistantship earnings, employment insurance (EI), income assistance, WCB benefits, disability benefits, child support, childcare subsidy, parents/guardians etc. Other income is the total from scholarships, bursaries, and merit awards, other sponsored sources, investments, gifts and income from sale of assets.
Applicant income / From Month/Year / To Month/Year / Amount
1.
2.
3.
Other income
Student Loans
Are you receiving Band sponsorship? Yes No Amount:
Total income/financial resources (Section D)
E. Essays
Please write ONEshort essay(2 pages)on one of the following topics:
- Leading through Change- How will your education enhance your career and prepare you to be a leader who can create change in your community or within the Nation?
- Learning Today for a better tomorrow-Within your discipline of study or interest, explain how you will apply the theory you are learning in your program in your community(practical application)
- RevivingNsyilxcen- Language embodies cultural values, beliefs and history. How would you support and assist in the revival of language and cultural practices in your community or within the Nation?
F. Application Requirements
All Applications must also include the following:
A personal letter outlining your biography why you should receive the bursary, your educational goals and future career aspirations.
A statement that tells us in your own words, how you are involved in your community(valued at 30 % of Application)
Most recent transcript of grades
A copy of your resume
A Reference letter from one of the following: a community member, instructor, advisor or employer. ( Must not be a family member)
G. Declaration
I understand that the information I have provided is subject to verification and audit. If I do not provide complete, accurate information or if I obtain or attempt to access financial assistance by fraudulent means I may be denied an Okanagan Nation bursary award now and in the future.
I consent to the exchange of information between appropriate financial institutions, schools, provincial and federal government ministries, departments and agencies solely for the purposes of verifying or investigating information pertaining to this application and related documents. Public announcements may be made indicating the amount of the bursary and the recipient’s name.
Signature of applicant / Date signed