Instructions: Please review our ECE Bursary information and criteria at www.ecebc.ca prior to filling out this form. Answer all questions in ink. Incomplete and/or illegible applications will not be accepted. Applications that are missing supporting documentation will not be considered Deadline for submission of bursary application forms is April 3, 2015. Application forms must be received at ECEBC by the April 3, 2015 deadline. Applications received after the deadline will not be considered. This bursary application form is four pages in length, please fill in all sections. Include a copy of your approved/received registration form with this application. Submit Winter 2015 transcript, showing grades for courses taken during the Winter 2015 semester (January to April 2015), to ECEBC by May 29, 2015. Winter 2015 transcripts received at ECEBC after May 29, 2015 will not be considered. Personal Information Last Name: First Name: Address: City: Province: Postal Code: Phone: E-mail: The following three questions are for the purpose of collecting statistical information regarding the students supported by the ECE Bursary fund. No personal information will be shared, and applicants privacy will be protected: Do you identify yourself as an Aboriginal person; that is, First Nations, Métis or Inuit? Yes No If you identify yourself as an Aboriginal person, are you First Nations, Métis or Inuit? Name of Institution: Campus: Student ID Program of Study: - - Social Insurance Number Full time / Part time: From January to April 2015 how many courses are you enrolled in? Both international and domestic students are eligible to apply for the ECE student bursary, however, proof of BC residency must be submitted with your application. Without proof of BC residency, ECEBC is unable to consider your application. Proof of BC residency includes a legible copy of your current BC driver s license, BC ID, or BC hydro bill. ECE Bursary Application Form Fall 2014 Semester Page 1 of 3
Career and Educational Goals: (If insufficient space, please attach additional letter) Living Arrangements Single student - living with parents Married/Common Law - no children Single parent Married/Common Law - with children Single student living away from home (# of children - ages of children ) (# of children - ages of children ) Financial Information To get a monthly figure: If you are attending school full time If your school runs on a semester basis, take the tuition amount that was paid for the semester and divide it by 4 (there are four months in a semester ) Otherwise take the tuition amount that you paid for the year and divide it by the number of months in your program if you are attending school part time Add up the tuition amount that you paid for each course you are taking and divide it by 4 (there are four months in a semester) PLEASE NOTE: Your application may be audited. Please keep all supporting documentation such as receipts, bank statements, cancelled cheques, etc. Giving false or misleading information could result in your application being denied. Page 2 of 5
MONTHLY INCOME Amount $ MONTHLY EXPENSES Amount $ Employment/self-employment Student loan (average) First Nations or Métis sponsorship Employment insurance Social Assistance Pension(s) BC family bonus Child tax credits Child care subsidy Child support Spouse income/spousal support Tax rebates (average) Commissions Bursaries/scholarships Support from parents Savings/Investments/RESP Other (specify) Rent/mortgage Groceries Medications (uninsured) Electricity, heat, and water Internet access Telephone/cell phone Child care Child school expenses (average) Child bus passes Child support payments Clothing (yourself and/or family) Bus pass (your own) Car/home insurance (average) Car payment Gas and parking Loan/credit card payment Other (specify) Tuition and ancillary fees Textbooks TOTAL MONTHLY INCOME TOTAL MONTHLY EXPENSES Please include all sources of income and all expenses. On a separate sheet of paper, please provide any other information that you feel may help in determining your financial need. Page 3 of 5
Authorization and Declaration I hereby declare that the information contained herein, all statements made and all supporting documents submitted in connection with this application are true, correct and complete. I understand that any misrepresentation or incomplete disclosure on or relating to this application may result in the cancellation of an award, or repayment of an award. I agree to provide ECEBC with proof of successful completion of the courses for which I am applying. I understand that successful submission of my bursary application and transcript does not guarantee that I will receive a bursary award. Winter 2015 transcripts, showing grades for courses taken during the Winter 2015 semester (January to April 2015), must be received by ECEBC by May 29, 2015. Successful completion requires a minimum of a passing grade. Applications received by email will constitute agreement of the above authorization and declaration. Signature of Applicant : Date: You may submit your application form by: e-mail: membership@ecebc.ca Fax: (604) 709-6077 Mail: ECEBC ECE Student Bursary Program 2774 East Broadway, Vancouver BC V5M 1Y8 Page 4 of 5
Before you submit your bursary application, don t forget to: Include proof of registration for the semester (this must include your name, number of courses you are registered in, semester and year). Complete all sections of the bursary application. This includes stating all expenses and all sources of income/financial assistance on page 3. Submit proof of BC residency. I have read and understand ECEBC s ECE student bursary policy. Submit your Winter 2015 transcript, showing grades for courses taken during the Winter 2015 semester (January to April 2015), by the deadline. Incomplete and/or illegible applications will not be accepted. Page 5 of 5