2011 Bursary Application Forms - DOC by fwh37072

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									                                                   Immersion Service Learning
                                           Bursary Application Form 2010-2011
Bursary awards are available for students participating in Immersion Service Learning. Bursary
awards are determined on the basis of financial need. Participation and bursary applications are
only processed when all Immersion Service Learning application forms and referee forms have
been received at the Service Learning Office, Rm. 414 Immaculata. For more information
contact the Service Learning Office: 867-2583. Deadline for Bursary Applications and
supporting documentation (see below) is Friday, October 29th, 2010.

PLEASE NOTE, YOU MUST PROVIDE THE FOLLOWING SUPPORTING
DOCUMENTATION WITH THIS FORM:
   1) A short essay (1 page maximum) explaining your financial situation and the
      importance of this bursary for you.
   2) If you have received a government student loan, please include a copy of your
      loan assessment.


Name: _____________________________ Date: ___________________


Telephone Number: __________________ E-mail: __________________


                          Confidential Financial Information

EXPENSES FOR THIS ACADEMIC YEAR:

   1) Tuition and prescribed fees (full time or part time):              $________
   2) Books and Supplies:                                                $________
   3) Instruments, equipment and special clothes:                        $________
   4) Residence Fees: $________ & Meal Plan: $________:                  $________
   5) Rent: $________per month x 8 months:                               $________
   6) Groceries $ ________ per week x 32 weeks:                          $________
   7) Local and return home transportation expected this year:           $________
   8) Contracted debts paid monthly: $ _____ x per month x 8 months: $________
   9) Telephone, electricity, heat, water $_____ x month for 8 months: $________
   10) Child care $ _____ per month x 8 months:                          $________
   11) Expected uninsured medical, dental, optometric costs:             $________
   12) Other: ______________________________________________ $________
                                                       TOTAL:            $________


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REVENUES FOR THIS ACADEMIC YEAR:

   1) The total amount of bursaries & scholarships from all sources in
      the current academic year:                                               $________

   2) The total amount of yearly contributions from parent(s), guardian(s),
       partner or spouses or other individuals:                                $________

   3) The total amount of yearly income from government sources and
      other agencies such as government pensions, band councils, social
      assistance etc.:                                                         $________

   4) The total amount of personal savings from summer/other earnings
      which will be used for this academic year:                               $________

   5) Expected part-time earnings over the course of this academic year:       $________

   6) Income from stipends relating to academic assistantships:                $________

   7) Income from student services / students' union related positions:        $________

   8) Total amount of government student loans you have been assessed
      to receive this academic year:                                           $________

   9) Total amount of government bursaries you have been assessed to
      Receive this academic year:                                              $________

   10) Total amount of bank loans you are receiving this academic year/or
       line of credit expected to be used this academic year:                  $________


What is your total amount of indebtedness up to the current academic year (student loans and
any other debts)? $________



I give permission to the Bursary Selection Committee to have access to my academic
record. I submit that the information submitted in support of my application is true to
my best knowledge at this time.



Signature: __________________________ Date: ___________________

     Please attach the required supporting documents (see page 1)!



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