UCN Awards Application 2012-2013

WINTER TERM

This personal information is being collected solely for use by the UCN Awards Selection Committee comprised of instructors and support staff at UCN. This information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act. If you have any questions about the collection contact the FIPPA coordinator, Box 3000, University College of the North, The Pas, MB, R9A 1M7. Phone 627-8500.

PART 1:Eligible AwardsDate submitted: ______

Please read below information carefully.
Please checks off the awards/bursaries below you are eligible for and ensure that you attach the required documentation for each award you check off. See UCN Financial Aid & Awards Handbook and/or award website for additionalcriteria/eligibility information and seek assistance as required. This handbook is available at UCN, and also at
If awards below request application to be submitted to UCN, only fill out one UCN Awards Application form for all Fall Term awardsyou are eligible and submit all required documents with your application package which would also include external applications (and required documents for them) to be submitted to UCN.Part 2 and Part 3 of the UCN Awards Application must be submitted as well.
  • It is the student’s responsibility to submit their UCN Awards Application package properly and completely with the required documents for all awards, which includes submitting their applications properly either to UCN or to an external address. Some awards listed below (including ones with external applications) are submitted to UCN, while others are mailed/faxed directly out (external awards) by applicant.
  • All below awards are for full-time students.
  • Students must have a GPA of 2.0 to apply for UCN Awards. Ask for clarification if needed.
  • Nursing students with U of M transcripts must submit unofficial transcript with their application package.
  • Please note that most (not all) “entrance” awards refer to recent high school graduates directly out of high school.
  • Regional Center students seek assistance from and submit UCN Award Application packages to Tanya Carriere, Financial Awards Officer at The Pas campus. Fax to (204) 627-8514 or mail c/o – Tanya Carriere, University College of the North, P.O. Box 3000, The Pas, MB, R9A 1M7.The Pas students submit to Enrolment Services reception. Thompson students submit to Enrolment Services and see Tammy Moen for assistance.
February 24, 2013
□ Student Association Council Bursary- $500 (The Pas only)
Apply using SAC application available at UCN, submit to UCN (Enrolment Services)
February 1, 2013
□Terry Fox Humanitarian Award
Apply using Terry Fox Award Application available at UCN or
February 1, 2013
□ Kin Canada Bursaries - $1000
Apply using Kin Canada application available at UCN or at
March 7, 2013
□ Natural Resource Management Technology Program Award - $500
Apply using UCN application, submit to UCN
March 7, 2013
□Governing Council Scholarship- $500
Apply using UCN application, submit to UCN
March 7, 2013
□Gordon Dick Memorial Award -$500(The Pas Only)
Apply using UCN application, submit to UCN
Essay required, see handbook
March 7, 2013
□ UCN Wechetotan Bursaries - $500 (MSBI)
Apply using UCN application. submit to UCN
March 30, 2013
□Business Council of Manitoba Aboriginal Education Awards - $3000, $2000 (College programs)
Application forms available from UCN or at
Various documents required, submit to UCN
April 30, 2013
□Moving Forward Together Scholarships – UCN and Manitoba Hydro - $2000, $500 depending on program
Separate application, available from UCN, submit to UCN

Award/Bursary cheques for selected recipients are expected to be issued after the completion of each term.
Search for additional awards/bursaries/scholarships/grants at:
and

UCN Awards Application 2011 -2012

If applications for UCN Awards are not complete, clear, and accurate they may be disqualified. Seek assistance if needed.

PART II:Personal Information

Name ______Student # ______Program ______Term ______

Program Length: Year _____ of ______( ie. Year 2 of 4 year program) or Adult Education Grade Level ______

Date of Birth ______Social Insurance No.______Ethnic background: □ Aboriginal □ Other

Permanent Mailing Address ______

Treaty # and Band # ______Phone number: H: ______C: ______

Gender □ Male □ Female Marital Status □ Married □ Common-Law □ Single □ Separated/Divorced/Widowed

Spouse/Common-law/Partner name ______□ Employed □ Unemployed □ Student

Are you a single parent? □ Yes □ No Number of dependant’s(living with you) ______

Funding Sources

Complete the table below to the best of your ability. You may have to refer to paperwork regarding income sources such as “Notice of Assessment”, sponsorship letter, etc. Indicate percentage in the amount column if applicable.

Full “F” / Partial “P” / Amount or Percentage / Sponsor/Source name
Canada/Manitoba
Student Loans/Grants / N/A
Manitoba Employment & Training Services / N/A
Parent/s, Relative, Donor / N/A
Band, Tribal Council, MMF
Other (indicate source)

Anything you wish to include regarding funding source(s) or about other funding sources you have or will be applying for?

______

______

______

______

PART III:Financial Needs Assessment

Name ______Student # ______Program ______Term ______

Term length (months): ______* Multiply amounts below by months of term unless not received monthly such as GST

Please Note: If your sponsor pays for tuition, books, or supplies, do not include these costs below as either incomeor expenses. If partially sponsored, indicate only amount that you pay. Also, when applicable only include non-subsided amounts for expenses. For example, only include child care portions, or rent amounts that you pay from income source(s).

Expenses (Present term only)
Multiply below monthly expenses
by months of term / Current
Term
Expenses
Tuition/compulsory fees / See
note
above
Books/gst
Supplies
Rent/mortgage (circle)
Utilities
Food (include cleaning products)
Transportation – gas, taxi, vehicle payments, insurance, etc.
Child Care
Dental/Medical
Laundry(coin laundry, soap, softener, etc.)
Basic telephone/cell/internet/cable
Miscellaneous (clothing, grooming, etc.)
Entertainment, activities for children
Bank loan /Student loan (list only if making payments)
Spousal/child support; settlements, etc.
(ie. divorce, MPI)
Credit cards (minimum payments only)
Other(indicate source):
Total Expenses (B)
Income (Present Term only)
Multiply below income amounts
by months of term / Current
Term
Income
Net Earnings (employment, pension, disability, etc.)
Savings from Spring/Summer employment
Partner’s net income
Sponsorship Training Allowance (All agencies)
Social Assistance (include rent and other expenses paid on your behalf)
Canada/Provincial Student Loans/Grants (divide total amount of loans/grants for year in half)
Child Tax Credit/Universal Child Care Benefit
Other Scholarships, award, grants, etc.
(if amount is to be used for year, divide in half)
Spousal/child support; settlements
(divorce, MPI, etc.)
Employment Insurance Benefits
Cash gifts from parents, donors, inheritances, RESP’s, Education savings, etc.
CRISP, WCB, orphans, disability, survivor benefits, etc.
GST to be received in term(Jan., Apr., July, & Oct.)
Other(indicate source):
Total Income (A)

Anything you wish to include regarding the above information?

______

______

Subtract total expenses from total income

Total Income: ______

Total Expenses: ______

Identified Need: + / - $______

(circle one)

I, ______(print), agree that the information I have provided in this application is accurate and estimated to the best of my knowledge. I also agree that I consent to be referred to the counselor or Financial Awards Officer should my need by higher than $2000.00 and I may be requested to provide further information.

Applicant’s Signature: ______Date signed: ______