YMCA of Greater Saint John Endowment Fund Inc. Bursary Application

Transcription

1 SECTION ONE: Personal Information YMCA of Greater Saint John Endowment Fund Inc. Bursary Application Financial Assistance Program To be completed by Applicant PLEASE PRINT CLEARLY Permanent Address: (please include postal code) Date of Birth: Day / Month / Year Telephone: ( ) SIN: Have you received a Y Bursary before? Yes No If yes, in what year(s): and in what amount(s): School, College or University you will attend in September: In what program will you be enrolling in September: Year: (1 st, 2 nd, etc.) List any degrees you will have by next September: Describe any physical or athletic activities in which you participate: Extracurricular Activities: Bursary Application Page 1 of 5

2 SECTION ONE: Continued Armed Forces Training, if any: Make a complete list of all scholarships, bursaries, grants or loans you will be receiving this year: (list name and value) NAME VALUE If required, please use a second page: Total Value: State the reasons you believe you qualify for the YMCA s financial assistance: Do you receive support in any way from your family: Yes No If yes, please have supporting persons (parents or guardians) complete Section Two of this application Are you are self supporting, i.e. living away from family home for several years, married etc.: If yes please omit Section Two. Type of employment during the past year: Yes No Bursary Application Page 2 of 5

3 Actual and expected gross earnings for the past 12 months ending August 31 st of the current year.. Other: Estimated expenses for Academic year commencing next September: SECTION ONE: Continued Tuition Fees Books Residence Other Total Expenses Will you be required to take up a temporary residence to attend university? Yes No Self Supporting : as an independent applicant, you must be permanently domiciled outside of the family home for a number of years and receive no financial support from that family. You are required to declare your status, income and assets as well as the status of anyone with whom you may have a partnership. You must provide sufficient detail to justify your financial need. It is recommended that you attach a detailed budget for the next academic year including revenues and expenses. Income, including partnerships, if applicable, for academic year including earnings/scholarships/bursaries and/or loans: to : Expenses for academic year: Total Income: Total Expenses: Declaration of Applicant I hereby certify that all the information provided in Section One of the application to be true, correct and complete in all respects. : Bursary Application Page 3 of 5

4 SECTION TWO: Supporting Parent or Guardians To be completed by parent(s) or guardian(s) in BLOCK LETTERS please: Parent/Guardian 1 Address: Relationship: Occupation: Home Phone: ( ) Street Work Phone: ( ) City/Province Postal Code Parent/Guardian 2 Address: Relationship: Occupation: Home Phone: ( ) Street Work Phone: ( ) City/Province Postal Code Parents /Guardians total combined gross annual income from all sources this year: Parents /Guardians annual contributions such as dwellings, clothing, auto and other financial benefits. Total pre-tax value:. Number of other dependent children attending a post-secondary institution: Number of dependent children living at home with your parents/guardians: Other supplementary information you wish to provide: I hereby certify that the information provided in Section Two if this application to be true, correct and complete in all respects. If only one parent/guardian s income is revealed, please explain. Bursary Application Page 4 of 5

5 SECTION THREE: Certificates of Educational Qualifications of Applicant To be completed by a representative of the institution where the applicant is at present or was last in attendance. This will certify that attended from to. Please indicate the anticipated educational attainment as at June of this year. (i.e. secondary school completion, 1 year, 2 years completed towards a degree program). Name Date Position MANDATORY: Copies of transcripts for all courses completed at time of submitting this application are required as well as a letter of confirmation with student identification number from the institute of enrollment. (University or Community College). Please include a letter written by the applicant outlining their goals and reason for submitting. SECTION FIVE: Submission Information The decision of the YMCA of Greater Saint John Endowment Fund Inc. Applications Committee is final. Notification will be given only to the students awarded the bursary. Successful applicants will be notified no later than June 30 th of the current year. ONLY COMPLETE APPLICATIONS WILL BE CONSIDERED BY THE APPLICANT COMMITTEE. ALL APPLICATIONS MUST BE RECEIVED BY APRIL 30th,2017. Please deliver or your completed application and all other documentation to: Bursary Committee YMCA of Greater Saint John 191 Churchill Boulevard Saint John, NB E2K 3E2 If you have any questions regarding this application, please call or at j.lowery@saintjohny.com. Bursary Application Page 5 of 5