For the Long Harbour Diversity Fund

89 McNamara DriveTel: 1-877-495-8585

P.O. Box 3040Fax: (709) 757-5437

Paradise, NL A1L 3W2

Application for Admission

For the Long Harbour Diversity Fund

Application must be accompanied by proof of Diversity Status.

I.e. Drivers License, Student ID or Letter from Disability Association.

College Applied for: ______

Course Applied for: ______

Personal Information

Name: ______

Last First Initial

Date of Birth: ______Male ______Female ______Year/Month/Day

Home Address: ______

P.O. Box Street Address City/ Town/ ProvPostal Code

Current Address: ______P.O. Box Street Address City/ Town/ Prov Postal Code

Home Phone ______Cell Phone ______email ______

Next of Kin: ______Relationship ______Tel ______

Last First Initial

Educational Information

I have a high school diploma yes _____ No _____

I am currently in high school Yes _____ No _____

I have been accepted in the College? Yes _____ No _____ (Please attach copy of acceptance letter).

* If your application is pending, please contact the college.

* If you do not have a high school diploma and are applying as a mature student, please contact the college administration office to schedule an appointment to write the mature student entrance exam.

General Information

Are you a registered apprentice with the Industrial Training Division, Department of Education?

Yes _____ please indicate which trade ______No _____

Are you currently eligible for Employment Insurance?Yes _____No _____

If yes, have your received education funding from Service Canada within the past four years. Yes ______No_____

*If declined for funding by Service Canada, please provide a letter of confirmation.

Are you eligible for funding, grants or scholarships from any other funding sources (i.e., AES)? Yes _____No _____

If yes, explain ______

If successful, how will you pay any outstanding fees not covered by the Diversity Fund?

Student Loan _____Self Pay _____ Other _____

If you are offered employment at the Long Harbour Nickel Processing Plant, would you accept the job?

Yes _____No ______Maybe _____

Are you willing to join the applicable union?Yes _____No _____

In the Space below, please indicate why you are interested in this program, and your reason for applying for this funding:

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OFFICE USE ONLY:

Date received: ______Meets Admission RequirementsYes ______No ______

Receipt # ______Meets Funding Requirements Yes ______No ______

Remarks: ______

______

I hereby declare that to the best of my knowledge, I have given full and true statement of all facts required. I agree to abide by all school rules and regulations. I understand that if I do not abide by these rules and regulations or fail to meet the requirement (grade) in my studies, I will relinquish the privilege of remaining as a student. I understand that any intentional damage resulting from careless use of property and / or equipment can result in instant dismissal and / or result in being responsible for all cost of repairs for damages incurred.

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Signature of applicantDateParent/Guardian (if under 18)

Office Approval ______Date______

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