North Shore Micmac District Council

Application for Post-Secondary Educational

Financial Assistance

Student Information

All Fields are mandatory

Please Print Clearly

Surname______FirstName______Initial______

Male______Female______Date of Birth_____/_____/_____/

D M Y

First Nation/Region______Band Number (10 digits)______

(attach photo copy of band card)

Application Status:

New Student ( )Re-Enrolling ( )Application Change ( )

Marital Status:Married ( )Single ( )Common Law ( )

If married, is your spouse employed?Yes ( )No ( )

Spouse’s Name ______Date of Birth ______/______/_____

D M Y

Dependents:Yes ( )No ( )Number of Dependents ______

Name of DependentRelationAge

______

(photocopy of long form of birth certificates or status card must be provided for each dependent.)

Email Address______please print clearly)

Home AddressAddress while at University/College

______

Telephone Number:Telephone Number:

(2)

Previous Education

Elementary/Secondary School:

Highest grade completed ______School ______

Upgrading:

To grade _____ Completed grade 12 Equivalency? Yes ( )No ( )

UCEPP/Bridging Year ______Where ______

University ______

Community College ______

Previous number of training months (if known) ______

Current Educational Plan

Institution______

Address______

______

______

______

Student Number ______

Type of Program:Certificate ( )Diploma ( )Degree ( )

Bachelors ( )Masters ( )PhD ( )

Program title ______Field______

Length of Program:Years ______Months ______Year of study: ______of ______

Study StatusFull-time ______Part-time______

Effective term(s) Semesters:Fall ______Winter______Spring ______Summer______

From ____/_____/______To______/______/______

Will you be residing Off-campus ( )On-campus ( )

(Students living away from home must submit their lease agreement or copy of utility bill with their name on it).

(3)

Student Declaration of Understanding

I hereby make application for post-secondary educational financial assistance and accept the following conditions for sponsorship:

  1. I have read, understood and agreed to the North Shore Micmac District Council’s Post-Secondary Education Policies and Guidelines as outlined in the NSMDC Student Handbook.
  1. To promptlyreport any changes to my student and/or program of studies;
  1. To promptlyreport voluntary withdrawal from studies as you will be held accountablefor the potential loss of refundable tuition dollars and any living allowance paid beyond this point;
  1. To meet the standards required by both the educational institution and the North Shore Micmac District Council’s Post-Secondary Education Program;
  1. to provide transcripts or statements of academic performance to the Post-Secondary Education Director at the end of each semester;
  1. I understand that any misrepresentation or omission of information is adequate cause for refusal or termination of funding by the North Shore Micmac District Council.
  1. I understand that all necessary documentation as referred to on page 5 must be included with my application in order for my application to be considered complete. I understand that incomplete applications will not be considered.
  1. I declare that I was a resident of Canada for (12) consecutive months prior to the date of this application for Post-Secondary Education support.

Student’s Signature______Date______

Please submit your completed application and documents to the following address:

North Shore Micmac District Council

Post-secondary Education

38 Micmac Road

Eel Ground, NB E1V 4B1

Email:

Fax: 506-627-4613

(4)

Release of Information

I give permission to ______to release my student

Information (tuition fees, course selection, transcripts, and my academic progress) for the

20______- 20______academic terms to Hazel Francis, Education Director of the North

Shore Micmac District Council’s Post-Secondary Education Program.

Student’s Name:______

Student’s Id #:______

Student’s Signature______

Date:______

Witness Signature______

Date:______

(5)

Your Application will not be considered complete

If the following are not attached:

  1. An acceptance or Provisional Acceptance Letter from the Educational Institution. If you provide a Provisional Acceptance Letter from the Educational Institution, you must provide a copy of your final acceptance letter as soon as it is received.
  1. Returning Students must provide their official transcript of marks from their previous year of study. High School students much provide their grade 12 transcript no later than a week after their June graduation.
  1. Proof of membership from your First Nation Band (Buctouche, Eel Ground, Eel River Bar, Fort Folly, Indian Island, Pabineau). Please include a photo copy of your Indian Status Card, both front and back.
  1. Proof of your living arrangements if you are not living with your parent(s)/legal guardians. Proof can include a photocopy of two utility bills, a photocopy of a rental receipt or your lease agreement.
  1. If you have dependents under the age of 18, attach a photocopy of each dependent’s long form of birth certificate.If you are a returning student and you have already submitted birth certificates of your dependents, you do not have to resend them.