BURSARY APPLICATION

ACADEMIC YEAR 2012/13

Please indicate which Bursary you wish to apply for

Hugh Duncan Bursary Application                 ¨
(full-time university studies)

Fondation I.F.E. Bursary Application              ¨
(full or part-time college (CEGEP) studies or part-time university studies)

Have you previously received a grant, either from ¨ Hugh Duncan Bursary Program or 
the ¨ I.F.E. Bursary Program

Date(s):   ____________________________________________________________________

SECTION A:GENERAL INFORMATION

Family Name  _____________________________   First Name ________________________________

S.I.N.*:   ______________________________

Address: Street:___________________________________________________

City:                ____________________________________________________

Postal Code    _____________________________________________________

Telephone #: (  ) _______________________________________________Home

                    (  )_______________________________________________ Work

(  ) _______________________________________________ Fax

                    (  )__________________________________________ E-mai

Name of Church: ____________________________________________________

Address:___________________________________________________________

            ____________________________________________________________

 

Institution/University you are attending/plan to attend:________________________

Degree Program:______________________________________________________

Expected Date of Graduation:____________________________________________

 

SECTION B: INCOME SOURCES

                                                                            Actual                    Estimate
                                                                            2011/2012          2012/2013

EDUCATION INCOME (for example scholarships, bursaries, grants,RESP’s or Loans)

Source______________________________
                                  Amount Received          ____________            ____________

Source
                                            Amount Received                   ____________                  ____________    

Source
                                            Amount Received                          ____________            ____________

EMPLOYMENT INCOME

Summer Job

Employer: _______________ Amount Received  _____________            ____________

Academic year part-time

Employer: _______________ Amount Received ______________            ____________

                                    INVESTMENT INCOME:  ______________            ____________

                                    TOTAL INCOME            ______________             ____________

                                  TOTAL INCOME          ______________         ____________

PARENTAL/OTHER CONTRIBUTION IF APPLICABLE( EX: LODGING, FOOD, CLOTHING, ETC.)

                                                        Amounts:   ______________            ____________

SECTION C: CERTIFICATION
 

Check List

  

Completed application form

Yes ____

  

Cover letter

Yes ____

  

Curriculum vitae

Yes ____

  
     
 

Check List

Date requested

Official Transcript

Yes ____

____________

Letters of reference (2)

Yes ____

____________

Certificate of membership
(or equivalent)

Yes ____

____________

 

CERTIFICATION

I certify that the foregoing information is correct and complete.

Signature: _____________________________       Date: _________________________

*required for tax purposes

HDBrsry App2013 English