Fillable Printable Student Bursary Application Sample Form
Fillable Printable Student Bursary Application Sample Form
Student Bursary Application Sample Form
WINTER 2015
ECE BURSARY APPLICATION FORM
ECE Bursary Application Form – Fall 2014 Semester Page 1 of 3
Instructions:
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 Social Insurance Number
Program of Study: 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.
Please review our ECE Bursary information and criteria at www.ecebc.ca prior to filling out this form.
WINTER 2015
ECE BURSARY APPLICATION FORM
Page 2 of 5
Career and Educational Goals: (If insufficient space, please attach additional letter)
Living Arrangements
Single student - living with parents
Single student – living away from home
Married/Common Law - no children
Single parent (# of children _________ - ages of children _________)
Married/Common Law - with 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.
WINTER 2015
ECE BURSARY APPLICATION FORM
Page 3 of 5
MONTHLY INCOME Amount $ MONTHLY EXPENSES Amount $
Employment/self-employment Rent/mortgage
Student loan (average) Groceries
First Nations or Métis sponsorship Medications (uninsured)
Employment insurance Electricity, heat, and water
Social Assistance Internet access
Pension(s) Telephone/cell phone
BC family bonus Child care
Child tax credits Child school expenses (average)
Child care subsidy Child bus passes
Child support Child support payments
Spouse income/spousal support Clothing (yourself and/or family)
Tax rebates (average) Bus pass (your own)
Commissions Car/home insurance (average)
Bursaries/scholarships Car payment
Support from parents Gas and parking
Savings/Investments/RESP Loan/credit card payment
Other (specify) 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.
WINTER 2015
ECE BURSARY APPLICATION FORM
Page 4 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:
Fax: (604) 709-6077
Mail: ECEBC
ECE Student Bursary Program
2774 East Broadway,
Vancouver BC V5M 1Y8
e-mail: xxx xxx
WINTER 2015
ECE BURSARY APPLICATION FORM
Page 5 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.
