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STUDENT APPLICATION PACKAGE

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Country of origin: CANADA
File type: PDF

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“Learning from the past, celebrating our present, preparing for our future”
Beausoleil Education Department
11 O’Gemaa Miikaan
Christian Island, ON
L9M 0A9
705-247-2051 Fax: 705-247-2239
STUDENT APPLICATION PACKAGE
Please note that the deadline for applying for Post Secondary Education Assistance for
students each year is:
Deadline: March 15
th
(For all semesters, pending available funds)
In order to process your application, the following criteria is required in our office by the
deadline date (faxed or emailed copies are acceptable, however, originals must be provided by mail).
1. Your written request explaining your education and career goals
2. Documents of previous education (photocopies are accepted)
3. A letter of acceptance from the College/University (asap)
4. Attached Post Secondary Application Form (completed and signed)
5. Attached Consent Form
6. PSSAP Acknowledgement Form
7. Post Secondary Student Contract (signed and dated)
8. Transcripts from High School for Grade 12 graduates
9. Transcripts from Post-Secondary for Continuing Students
10. A letter of reference from previous employer or professional (for part-time or
Distance Education programs)
Contact the Education Office if you need assistance in completing or accessing
any of the letters to avoid unnecessary delays of missing the application
deadline date. Incomplete applications will not be considered.
“Learning from the past, celebrating our present, preparing for our future”
Beausoleil Education Department
11 O’ Gemaa Miikaan
Christian Island, ON
L9M 0A9
705-247-2051 Fax: 705-247-2239
POST SECONDARY APPLICATION FORM
Section 1: PERSONAL INFORMATION
Legal Surname:
Given Names:
Date of Birth: (mm/dd/yyyy)
Gender: M F
Home Address:
Address while at school: (if different)
Will you be living with your parent(s) during your period of study? Yes No
10 digit Band Number: Email Address: (required)
Cell Phone: Alternate Contact Phone:
Emergency Contact:
Emergency Contact Telephone:
Spouse’s Name:
Marital Status: Single Single Parent
Married/Common Law
Number of dependents: ________
(Attach a copy of birth certificate & status card)
Name(s)
Date of Birth (mm//dd/yyyy) Relationship
“Learning from the past, celebrating our present, preparing for our future”
Section 2: EDUCATIONAL PLAN
What is the name of the Post Secondary institution you plan to attend? (e.g. York University)
Which campus or college of the above institution will you be attending? (If applicable, e.g. Barrie
Campus)
In which city/town is the above institution located?
What is the name of your program? (e.g. Business, Accounting, Chemical Engineering)
What is the Program start date? From: __________ To: __________
(mm/yyyy) (mm/yyyy)
Which term(s) will you start your period of study? Spring Summer
Fall Winter
Will you be attending school? Full-time or Part-time
Method of Delivery? Classroom Distance Education On-line
Blended: Classroom and Distance Education
Blended: Classroom and On-line
Level of Education sought?
1. Certificate 2. Diploma 3. Bachelor’s degree
4. Master’s degree 5. Doctoral degree
Which year of your program will you be entering? (e.g. year 1, 2)
Academic Program Length? (e.g. 3 years, 4 years)
Is there a cooperative education (co-op) program that is mandatory? Yes No
What term(s) are the co-op? Spring Summer Fall Winter
What percentage of a full course load will you be taking? %
“Learning from the past, celebrating our present, preparing for our future”
PLEASE LIST ALL SECONDARY SCHOOLS ATTENDED OR BEING ATTENDED
Year to Year Name of School Address of School (City, Province) Diploma
(Attach a copy)
Have you ever taken full-time post-secondary studies? Yes No
PLEASE LIST ALL POST-SECONDARY SCHOOLS ATTENDED OR BEING ATTENDED
Year to Year Name and Location of School Year/Level Program
Have you been sponsored by Beausoleil First Nation before? Yes No
If yes, what year? _________
Did you successfully complete your last year of school attended? Yes No
Are you scheduled to continue into the next year? Yes No
Date scheduled to graduate? ___________________
(mm/dd/yyyy)
Is there a deadline for tuition? Yes No
If yes, what is the date? ___________________________
(mm/dd/yyyy)
Are you planning on living in Residence? Yes No
If yes, what is the deposit date deadline? ______________________________
(mm/dd/yyyy)
“Learning from the past, celebrating our present, preparing for our future”
Section 3: APPLICANTS’ DECLARATION AND SIGNATURE
Please provide best estimate for the following:
- tuition costs and mandatory fees
- residence fees, meal plan, etc. (living allowance)
- books
Tuition: $_________
Living Allowance: $__________
Books: $___________
I request financial assistance from Beausoleil First Nation to undertake my
post-secondary studies in the amount of $_________________________
It is student’s responsibility to opt out of any optional fees (e.g. health & dental)
I will use this assistance to pay the costs associated with my program of studies. I authorize Beausoleil
First Nation to collect, use and disclose data and information on verifying any information related to
any assistance I have given complete and true information on this form and I understand that failure
to do so may prevent my qualifying for assistance in the future. I understand that if I should receive
assistance, it is awarded to me on the condition that it will be used for the purposes for which it was
intended. I understand that if I do not respect this condition, it may result in loss of eligibility for
future Beausoleil First Nation funding.
I understand that, in respect of assistance, if I knowingly make a false statement or
misrepresentation in an application or other document or willfully furnish any false or
misleading information I will not be provided with any assistance in the future.
X__________________________ __________________
Signature of Applicant Date
(mm/dd/yyyy)
The information on this form is collected under the authority of the
Freedom of Information and Privacy
Act.
This information will be used to determine and verify the client's eligibility for the purposes of post-
secondary funding under the Beausoleil First Nation Post-Secondary Student Assistant Policy and
framework. If you have questions, please contact Nancy Assance at 705-247-2051.
** Please attach a void cheque or Direct Deposit authorization form **
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“Learning from the past, celebrating our present, preparing for our future”
Beausoleil Education Department
Beausoleil First Nation
11 O’Gemaa Miikaan, Christian Island, Ontario L9M 0A9
POST SECONDARY STUDENT CONTRACT
As a student sponsored by the Beausoleil first Nation, under the Post-Secondary Student Assistance Policy, I
agree to and accept the following conditions and responsibilities:
1. To satisfy the academic requirements specified by the institution, including attending all classes, or as
outlined under “Probation” in the Post-Secondary Education guidelines.
2. The educational assistance is not intended to be sufficient to pay off personal debts.
3. Proof of dependents must accompany the application form. Copies of birth certificate and status card
are acceptable.
4. No collect calls will be accepted by the Education Office.
5. Any program changes, including course withdrawals must be approved by an Education Manager from
the college or university with final approval by the Education Director.
6. Notify the Education Department immediately if withdrawing from the school and to complete the
necessary withdrawal forms.
7. College or University transfers to be submitted early so as to avoid being enrolled in a second choice
program.
8. When tuition or residence fee payments are required, such notice will be forwarded to the Education
Department immediately. Delays may mean losing a place in a program or residence.
9. Transcripts for each school semester must be submitted to the Education Department as soon as they
are available from the college or university.
10. That should a student receive educational assistance to which he/she is not entitled, he/she will be
required to repay the full amount before further assistance is approved.
11. Invoices/receipts be submitted to the Education Department.
12. Notify the Education Director of any changes in information supplied on the application.
If one or more of the above conditions or responsibilities are not
met, educational assistance will be
withdrawn. I understand and agree to the above conditions and responsibilities.
___________________________ Date: _______________________________
Student Signature
________________________________ Date: _____________________________________
Director’s Signature
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“Learning from the past, celebrating our present, preparing for our future”
Beausoleil First Nation Education Department
11 O’Gemaa Miikaan, Christian Island, Ontario L9M 0A9
Consent to the Disclosure or Release of Information
Pursuant to Section 42(b) (c) of the Freedom of Information and Protection of
Individual Privacy Act.
჻
As a condition to students receiving financial assistance from the Post Secondary Student
Assistance Policy, the Beausoleil Education Department requires the student to sign a
Consent to the Disclosure or Release of Information
.
Name: ______________________________________________________________________
College/University: _____________________________________________________________
Student Number: ________________________
Program: ______________________________________________________________________
Financial: ______________________________________________________________________
As a sponsored student through the Beausoleil First Nation Post-Secondary Student Assistance
Policy, I, ________________________________ consent to the release of information to the
Beausoleil Education Department.
჻
This form will provide Beausoleil Education Department with information pertaining to
academic performance, attendance, progress reports/transcripts or any other financial
information requested.
________________________________ Date: ___________________________________
(Student Signature)
________________________________ Date: ___________________________________
Education Director’s Signature
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STUDENT APPLICATION PACKAGE

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Completed 31 January 2022

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