Fillable 2022-2023 Garay Family Award for Indigneous Students in (Carleton University)

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2022-2023 Garay Family Award for Indigneous Students in (Carleton University)

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Country of origin: CANADA
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Page 1 of 8
2022-2023 Garay Family Award for Indigneous Students in Science Application
Awarded to an outstanding Indigenous student in demonstrated financial need who is entering a full-
time undergraduate degree program in Science at Carleton University. This award may be continued
for 3 subsequent years of full-time enrolment provided the recipient remains in good academic
standing and continues to demonstrate financial need. Endowed in 2021 by the Garay family.
This entrance award is valued at $4000 for the 2022-2023 academic year.
Application Deadline: June 1, 2022
Successful candidate will be notified by June 30
th
, 2022
General Eligibility Criteria
• Indigenous student entering the first year of full-time study at Carleton University
• Applied and admitted to an undergraduate degree program in Science
• Entering full-time study this fall
• Demonstrate financial need
• Demonstrated diligence through academic work
• This award is renewable over the first four years of undergraduate study provided the recipient
continues in a Science program, maintains full time enrolment, remains in good academic
standing and continues to demonstrate financial need.
• If the award is lost in one year, it cannot be regained in a subsequent year
Instructions
1. This is a fillable form. Please complete and submit this application to the Awards Office (if the
deadline date lands on a weekend, application must be submitted the first working day after the
deadline date).
2. Students should not include any additional attachments (e.g.resumes, portfolios, photos,
certificates, etc.).
3. Incomplete applications will not be considered
4. Submit by June 1 to:
Awards Office Fax: 613-520-3560
Carleton University email: awards@carleton.ca
SECTION 1: Personal Information
____________________________________
Last Name
_____________________________________
First Name(s)
____________________________________
Home Address: Unit, # and Street
Page 2 of 8
_____________________________________ ________________________________________
City Prov/Territory Postal Code Carleton Program Year Faculty
(____)________________________________ ________________________________________
Telephone Carleton Student Number
________________________________________
Signature
Section 1: Personal Information (continued)
Indigenous Status: Voluntary Declaration
I hereby state that I am an Indigenous student. This assertion means that I identify as a member of
the First Peoples of Canada meaning, in general terms, First Nation, Metis, Inuit, Indigenous, or
specifically by my home community or my Nation
Non-Indigenous
Other
SECTION 2: Statement of Interest
Describe your academic and future goals and tell us how attending Carleton University will assist you
in achieving them:
Page 3 of 8
SECTION 3: Community Involvement
Describe what you would consider to be your most important contribution to your community (you may
include any extra-curricular activities at your secondary school, sports, volunteering, working with
elders and/or youth etc.):
SECTION 4: Statement of Financial Need
Please provide an explanation of financial need:
Page 4 of 8
Where will you live when you attend University?
Home: Away from home: Residence:
Status
Option 1
I am a single student with no dependents Year I graduated High School ______
Note: If you have been out of high school for 4 years or more, you do not need to include your
parents' financial information. If you have been out of high school for less than 4 years you must
provide your parents' financial information.
Father’s Occupation: ____________________
Gross Annual Income: ____________________
Mother’s Occupation: ____________________
Gross Annual Income: ____________________
Ages of your brothers and sisters still in school: __________________________________________
Option 2
I am married/Common Law or a Sole-Support Parent:
Spouse’s Occupation: ____________________
Gross Annual Income: ____________________
Number of Dependent Children: ____________
Do you plan to apply for OSAP student assistance (or government student aid from your home
province) for the academic year?
Yes:
No: if no, please explain_____________________________________________________
Will you be receiving tuition sponsorship or partial band funding for the upcoming academic year?
Yes:
No:
Page 5 of 8
Please complete a budget for the upcoming academic year (8 months, September to April).
Expenses
Resources (income/other financial assistance)
Tuition
Savings as of Start of Study
Period
Books/Supplies
Parents/Relatives Contribution
Government Student Loans
Other Related Educational
Costs (specify)
Scholarships, Bursaries & Grants
Rent/Residence
_____x __ months____
Part-time Earnings
Food
_____x __ months___
Utilities
_____x __ months___
Telephone & Internet
_____x __ months___
Student Line of Credit (amount
intended for use this session)
Personal Items
_____x __ months___
Other (specify)
Laundry
_____x __ months___
Uninsured Medical/Dental
Expenses
Total Resources
Eyeglasses/ Contacting
Lenses Replacement
Entertainment
_____x __ months___
Transportation:
Local
Home/flight
Clothing
Minimum Credit Card
Payment
_____x __ months___
Minimum Student Line of
Credit Payment
Other (specify)
Total Expenses
Calculated Need
$
(Total Expenses minus Total Resources)
Page 6 of 8
Student’s Declaration
I authorize Carleton University to release a copy of this application to the appropriate awards selection
committee(s) and to the award donor, including my academic record and financial need information in order to
adjudicate my application for an award. If requested, I agree to provide the Awards Office with any
documentation necessary to verify the information on this application. I declare that the above information is
true and accurate. If any information is inaccurate, I understand that an award may be reassessed and/or
withdrawn.
Signature of Student Date
At Carleton University, we recognize and respect the importance of privacy. Personal information that we collect is kept
confidential. In accordance with section 41 of the Freedom of Information and Protection of Privacy Act, Carleton University
will only use the information in its custody or control in the following circumstances: where the individual identifies the
particular information and consents to its use; for the purpose for which it was collected or a consistent purpose (i.e. a
purpose which the individual might have reasonably expected).
The Awards Office allows for disclosure or exchange of information to external and internal bodies as required determining
eligibility/ suitability for awards and the release of identifying information that may include name/contact/program / year, to
award donors and university units advising them of award recipients. From time to time, the university may also post this
information in public forums, such as websites and/or notices or use this information for statistical or reporting purposes to
agencies that have the authority to ask for such information. If you have questions and/or do not agree to the release of
identifying information, please contact the Awards Office FIPPA Liaison Officer at awards@carleton.ca.
Return by June 1, 2022:
Phone: 613-520-3600
Garay Family Award for Indigenous Students in Science Award Committee
c/oAwards Office Fax: 613-520-3560
Carleton University
awards@carleton.ca
Page 7 of 8
Referee Form – Academic
____________________________________________
Name
____________________________________________
Address
This student is applying for the Garay Family Award for Indigenous Students in Science. Please
provide a statement of recommendation for this applicant describing their academic achievements.
You are asked to complete and return this form to the student or email us the form directly at:
awards@carleton.ca. Please include the student’s full name in your email. Individuals completing the
reference on behalf of the student may choose to submit their recommendation as a separate
attachment or letter.
Recommendation – To be completed by an academic official (teacher/professor, guidance
counsellor, principal).
*If you wish to write more than the space allows, simply continue on the back of this page, or attach a letter
_____________________ __________________________ ______________
Signature Print Name Date
____________________________ ___________________________
Educational Institution Position
Page 8 of 8
Referee Form – Community Leader
____________________________________________
Name
____________________________________________
Address
This student is applying for the Garay Family Award for Indigenous Students in Science. Please
provide a statement of recommendation for this applicant regarding their contributions and
involvement in the community. Please include your personal observations and experience with the
candidate’s contribution to the community.
You are asked to complete and return this form to the student or email us the form directly at:
awards@carleton.ca. Please include the student’s full name in your email. Individuals completing the
reference on behalf of the student may choose to submit their recommendation as a separate
attachment or letter.
Recommendation – To be completed by a community leader (Member of Chief and Council, elders,
staff at a community-based Indigenous organization, etc.)
*If you wish to write more than the space allows, simply continue on the back of this page, or attach a letter
_____________________ __________________________ ______________
Signature Print Name Date
____________________________ ___________________________
Title Organization (if applicable)
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2022-2023 Garay Family Award for Indigneous Students in (Carleton University)

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Completed 12 May 2022

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