Fillable BURSARY APPLICATION FORM MTIS NATION OF ONTARIO

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BURSARY APPLICATION FORM MTIS NATION OF ONTARIO

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The BURSARY APPLICATION FORM MTIS NATION OF ONTARIO form is 5 pages long and contains:

  • 4 signatures
  • 5 check-boxes
  • 60 other fields

Country of origin: CANADA
File type: PDF

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1
BURSARY
APPLICATION FORM
MÉTIS NATION OF ONTARIO
2
Instructions:
01. All sections must be fully completed in order for your application to
be considered.
02. Students must meet the following requirements in order to be eligible for
bursary assistance.
03. Completed applications should be submitted to the
04. The bursary does not have to be paid back but it is considered taxable income.
Be Métis; Be taking at least 6 credits at the University of Sudbury in the current
academic year; Fill out and submit an application form, before the deadline!
Janelle Radey, jradey@usudbury.ca
following individual:
3
Please ll out the following:
STUDENT NAME: __________________________________________________________________
STUDENT #: __________________________________________________________________
ADDRESS: __________________________________________________________________
____________________________________________________________________________________
BURSARY NAME: ___________________________________________________________________
BURSARY OFFERED BY: _____________________________________________________________
EMAIL: ____________________ TEL: (______)___________________
DATE OF BIRTH: _________________________ S.I.N. # ________________________
D/M/Y
PROGRAM NAME: _________________________________________________________
PROGRAM YEAR: 1st 2nd 3rd 4th CAMPUS: __________________________
(if applicable)
Métis Nation of Ontario Citizen: Yes No
If yes, please give card #: ____________________________________________________________
If no, please read and sign if you agree with the following statements:
I hereby afrm that I am Métis
I reside in the Province of Ontario
I am not registered as an Indian under the Indian Act or as an Inuk on an Inuit registry.
Privacy and condentiality Policy and Authorization for use of information: This information is used to determine
program eligibility. The Métis Nation of Ontario may disclose such information where we are legally authorized to do
so. All information collected will be kept strictly condential and will be protected.
STUDENT CONSENT: If awarded a bursary, I hereby grant permission for my name to be used by the Métis Nation
of Ontario and/or the post-secondary institution for the purpose of promotion and marketing of the bursary program
________________________ ________________________ __________________
Client Signature Witness Signature Date
PARENTAL CONSENT: If the applicant is under the age of 18
_____________________________
Parent Signature
(if applicable)
(if applicable)
(Name of community council or institution)
(if you are not a citizen of the MNO and you are applying for a Métis community council bursary you
may provide a parent or grandparent’s MNO citizenship card #. Please indicate their full name and
relationship to you on the same line.)
University of Sudbury
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signature
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signature
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signature
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4
School Year Budget
This budget is based on the following study period:
Start Date: ____/_____/_____ End Date: ____/_____/______
Day/Month/Year Day/Month/Year
RESOURCES EXPENSES
Bank balance at beginning of term
including savings from work-term
$ Tuition and compulsory fees $
Parental contribution $ Books/supplies/instruments/tools $
Spouse’s net income
$ ____________ x __________ mths
$ Transportation: local and home $
Academic awards $ Rent: $ __________ x ________ mths $
Total OSAP $
Utilities:
$ _______ x _____ mths
Phone:
$ _______ x _____ mths
$
Net part-time earnings $ Food: $ ________ x _______ months $
Other income: (Ontario Works, ODSP,
Child Tax Benet, etc.)
$
Personal Hygiene:
$ _______ x ______ months
$
Other Métis funding (MNOET, etc.) $ Child care $
Support Payments $ Clothing $
Gifts $ Laundry: $ ____ x ____ mths $
Investment income $ Entertainment: $ ___ x ___ mnths $
Other resources: (please specify) $
Uninsured medical/dental (Receipts
required)
$
TOTAL RESOURCES FOR SCHOOL TERM $ TOTAL EDUCATION EXPENSES $
FINANCIAL ASSISTANCE NEEDED
(Resources minus Expenses)
$
Declaration: I declare that the information provided on this application is accurate and a true statement of my
nancial position.
Student Signature: __________________________________ Date: _______________
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signature
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5
Métis Nation of Ontario Bursary Award
Essay (if you are applying for a Post-Secondary Bursary or if applicable)
Please answer the following questions:
1. Why are you interested in your area of study?
2. Describe how your studies will contribute to your future employment/employability?
If you are applying for a Métis Community Council Bursary, please answer the question
provided to you by your Council.
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BURSARY APPLICATION FORM MTIS NATION OF ONTARIO

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Completed 5 February 2021

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