post-secondary education financial assistance · post-secondary education financial assistance...

WESTBANK FIRST NATION

Schedule B

APPLICATION FORM FFOORR

PPOOSSTT--SSEECCOONNDDAARRYY EEDDUUCCAATTIIOONN FFIINNAANNCCIIAALL AASSSSIISSTTAANNCCEE

Westbank First Nation, Education Services 11990000 QQuuaaiill LLaannee

WWeessttbbaannkk,, BBCC VV44TT 22HH33 TT 225500 776688--00222277 FF 225500 776688--00552288

STUDENT’S NAME

DATE RECEIVED BY WFN


POLICY MANUAL

SUBJECT:

Post Secondary Education

The information you provide on this document is for the purpose of researching and administering post-secondary student financial assistance. Personal information that you provide is protected under the provisions of the Privacy Act.

HAVE YOU EVER BEEN FUNDED FROM WESTBANK FIRST NATION PREVIOULY? □ YES □NO

IF YES, DID YOU COMPLETE THE PROGRAM: □ YES, WHAT PROGRAM ___________________________ □NO IF NO, WHY DIDN’T YOU COMPLETE? _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

STUDENT PROFILE LAST NAME FIRST NAME MIDDLE INITIAL___ ____ DATE OF BIRTH ________ S.I.N._______________________________STATUS #_______________________________ PERMANENT ADDRESS CITY/TOWN ________P.C.____________ ADDRESS WHILE ATTENDING SCHOOL CITY/TOWN____________________________P.C.____________ PHONE # (CURRENT) _____ PHONE # (PERMANENT)__________________EMAIL: ____________________________________ SEX M F MARITAL STATUS: SINGLE MARRIED/COMMON LAW DIVORCED SEPARATED WIDOWED DEPENDANTS RESIDING WITH APPLICANT NAME AGE (mm/dd/yyyy) RELATIONSHIP STATUS

NAME OF NEXT OF KIN_______________________________________________RELATIONSHIP___________________________________ ADDRESS______________________________________________________POSTAL CODE_________________PHONE_________________

HOUSING: Band Private (Own) Private (Rent) College/University Residence With Parent(s)/Guardian If, Band Housing: Do you authorize WFN Education to deduct? Yes , Amount $_____________ _ No, I will pay WFN Signature of Authorization: ____________________ Date: ___________________

BANKING INFORMATION (For Direct Deposit Purposes) OR Attach voided cheque here or complete below

NAME OF BANK______________________ ACCOUNT # TRANSIT # ADDRESS OF BANK_____________________________ TOWN: PROVINCE


POLICY MANUAL

SUBJECT:



PREVIOUS EDUCATION AND TRAINING School / Training

Name Location Program Completed

Yes No

Year of Completion

Certificate / Diploma / Degree

Received Secondary / High School

Community College

Technical Institute

Private

University

Other (Specify)

POST-SECONDARY INSTITUTION INFORMATION

NAME OF INSTITUTE ACCEPTED TO:__________________________________________________________PHONE___________________

ADDRESS_______________________________________________________________________________FAX_____________________

INSTITUTION TYPE COLLEGE UNIVERSITY UNIVERSITY COLLEGE OTHER INSTITUTION

SESSION APPLIED FOR FALL WINTER SPRING SUMMER ARE YOU STUDYING FULL-TIME PART-TIME

PROGRAM/COURSE NAME_________________________________________ AREA OF STUDY:________________________________

DOES YOUR PROGRAM REQUIRE: INTERNSHIP PRACTICUMS CO-OP

IF YES, EXPLAIN: _____________________________________________________________________________________________

ARE YOU REGISTERED WITH WFN EMPLOYMENT COORDINATOR? YES NO

QUALIFICATION SOUGHT NON-UNIVERSITY TYPE DIPLMOA/CERTIFICATE

UNDERGRADUATE

(E.g. Bachelor degree; first professional degree; university type certificate or diploma)

GRADUATE

(E.g. License graduate; Master’s degree and qualifying year; PhD and qualifying year; earned Doctorate;

graduate level certificate or diploma)

OTHER (e.g. Adult Basic Education Upgrade / Courses shorter than one year)

LENGTH OF PROGRAM (per institute) YEAR OF STUDY YEAR(S) OF SPONSORSHIP REQUESTED

Office Use Only CC# ___________


POLICY MANUAL

SUBJECT:



LETTER OF INTENT (See section on “Letter of Intent Template” in the Post Secondary Education Policy; attach a separate sheet)

SAMPLE LETTER OF INTENT SAMPLE Letter of Intent Date (Remember deadline dates are: May 31st for the September start date) Name (First, Middle Initial, Last) Mailing Address: Address, City, Province Postal Code To: Denise Clough, Education Services Manager Re: Post Secondary Student Support Request Introduce yourself; include your band number, parents, and grandparents. Briefly outline your education and career goals. Let her know if you were funded before and how the program you are applying for supplements your overall career goal. Let her know your plans such as what course/program you want to take, where you want to take it, why you want to take it and the start and end dates. State exactly what you are requesting by way of funding (here is a list of funding available, if eligible) Living Allowance, Tuition, Books, & Travel. If you already received your acceptance letter this would be a good time to send it with this letter. Add anything else that you think may persuade her to choose you as our sponsored student such as, career goals that you have, or hardships you have endured, how your education will help your community. Then thank them for her time and consideration. Sincerely, (Sign your name here) Name of Applicant Status # Student # Enclosure(s): List any documents you are including with this letter such as: Acceptance Letter and Banking Information Completed and application


POLICY MANUAL

SUBJECT:



By completion of this form, I hereby authorize the Registrar’s Office to release:

Transcripts Confirmation of Registration Attendance Records

(PLEASE PRINT) __________________________ ________________________ ______________________ Last Name Given Names Student Number _____________________________ ______________________ _______ ____________ Address City Province Postal Code to:

EDUCATION SERVICES Westbank First Nation

1900 Quail Lane Westbank, BC V4T 2H3

_________________________________________ _____________________ Student’s Signature Date


Post Secondary Individual Education Plan

Schedule D

EDUCATION SERVICES 1900 Quail Lane, Westbank, BC V4T 2H3

Tel: (250) 768-0227 Fax: (250) 768-0528

By accepting the educational funding provided by Westbank First Nation for the period _____________ to _______________, I hereby acknowledge and agree that I may be required to repay the educational funding allotted to me during this period, in full or in part, to the Westbank First Nation on demand if any of the following occur: I have withdrawn from academic post-secondary courses without informing the WFN within ten (10)

days of my change in status; My course load drops below the minimum required to meet the sponsorship requirements as stated in

the Westbank First Nation Post-Secondary Education Student Support Program Policy and Guidelines Handbook;

I fail to disclose funding from other sources and/or employment income received during the period for

which I receive educational funding. [Note: disclosure of income does not necessarily result in cancellation of funding from WFN.];

I also acknowledge and agree that should I fail to achieve good academic standing, as outlined by my program of studies for which I have been sponsored, if I quit before completion, or decide to change my program of study, I must serve an academic penalty as outlined below. If I quit/fail/change program of study…..first time……….one year without WFN sponsorship If I quit/fail/change program of study…..second time…..two years without WFN sponsorship

STUDENT DECLARATION: I declare and affirm that the information provided by me on this application form is complete and correct and is given in order to substantiate my entitlement to educational financial assistance.

I agree to advise the Westbank First Nation Education Department of any change in my course load, financial status, marital status, family size, or other circumstances that may affect my eligibility for benefits.

I accept responsibility for satisfying the academic or training requirements of the above institution and managing the educational assistance funds to the best of my ability.

I authorize the Westbank First Nation Education Department to disclose any information in this application to such source or any such reporting agency, in order to verify or confirm the information.

I acknowledge that educational financial benefits obtained under false pretence or misrepresentation may lead to prosecution under the Criminal Code of Canada.

Signature of Applicant Date Signature of Parent / Legal Guardian Date (if applicant is under 19 years of age) Signature of Witness Date


Post Secondary Individual Education Plan


Semester 1 Semester 2

Course Credit Hours Course Credit Hours

YEAR 2 Semester 3 Semester 4






TOTAL TUITION OF PRORAM: _________________________

post-secondary education financial assistance · post-secondary education financial assistance...

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