Student Name (Last/First)
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Alberta Student Number
Date of Birth
Day Month Year
Send documents electronically: 1. Visit studentaid.alberta.ca 2. Sign in to your account 3. Submit securely using Upload Electronic Document(s)
Or email to: AE.AlbertaScholarships@gov.ab.ca
Or mail to: Alberta Student Aid, PO Box 28000 Stn Main, Edmonton AB T5J 4R4
PO Box 28000 Stn Main
Edmonton AB T5J 4R4
Canada
Last revised August 2019
2
Alexander Rutherford Scholarship Residency Resumé
For Parent/Legal Guardian Information
Advanced Education is collecting this personal information under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act (Alberta) (“FOIP”) to verify your eligibility for a
scholarship under the Alberta Heritage Scholarship Act. The use and disclosure of your personal information is managed in accordance with FOIP.
If you have any questions about the collection, use or disclosure of this information, contact Alberta Student Aid, Box 28000 Station Main, Edmonton AB T5J 4R4, or email AE.Albertascholarships@gov.ab.ca
Parent/Legal Guardian 1 Information Parent/Legal Guardian 2 Information
FROM TO RESIDENCE ADDRESS
Month Year Month Year City & Province/State & Country
FROM TO RESIDENCE ADDRESS
Month Year Month Year City & Province/State & Country
Relationship to Student Relationship to Student
Born in Canada?
Yes If yes, indicate province
No If no, enter arrival information:
Born in Canada?
Yes If yes, indicate province
No If no, enter arrival information:
Current Citizenship:
Canadian
Permanent Resident
Protected Person Current Citizenship:
Canadian
Permanent Resident
Protected Person
Date Arrived in Canada
Day Month Year
Date Arrived in Alberta
Day Month Year
Date Arrived in Canada
Day Month Year
Date Arrived in Alberta
Day Month Year
