Camp Bursary Application Form
It is important that every child has the chance to experience the opportunities and friendships that come with attending
camp. Minds in Motion is pleased to offer full and partial bursaries to families that require assistance. Please read through
the following information and complete the application form that is attached. To aid the bursary process, please fill in each
section/question to the best of your knowledge. Application must be fully completed in order to be considered.
Bursary amounts are based on the most recent Canadian Federal Low Income Cut Offs - Before Tax amount. However, we
take every applicant’s circumstances into consideration and full and partial bursary amounts are ultimately awarded on a
case by case basis.
Bursary Application Procedure:
1.
2.
3.
4.
5.
Please register your child(ren) for the camp that you are applying for prior to submitting your Bursary Application
Form. You will be expected to pay for the camp session in full at this time (this is to hold a spot for your child(ren)
in the camp).
Submit the completed Bursary Application Form (submission instructions below).
Your Bursary Application Form will be reviewed and considered within two weeks. At this time you will be notified
by e-mail or phone about your Bursary status.
If your application is successful, we will refund you the amount of the Full or Partial Bursary awarded.
If your application if unsuccessful, you may withdraw your child(ren) from the camp with a full refund, or leave
your child(ren) enrolled.
Supporting Documentation Required:
Please be sure to include at least one of the following supporting documents below with your application. While reviewing
your specific case, Minds in Motion may request additional supporting documentation to verify your eligibility.
1.
2.
3.
4.
5.
6.
T
E
W
Taxation Notice: For each adult in the household, please provide a copy of their current, official Canada Revenue
Agency Notice of Assessment, which includes Line 150 (total income).
AISH: If you are receiving AISH, please provide us with a current document that demonstrates this.
Income Support: If you are receiving Income Support, please provide us with a current document that
demonstrates this.
Alberta Child Health Benefit: Please provide us with a letter stating that you are currently eligible for the Alberta
Child Health Benefit. To obtain this letter, please call Alberta Works Contact Centre at 1-866-644-5135
Alberta Adult Health Benefit: Please provide a copy of your Alberta Works Letter that has your full name and
shows that you are currently on this program. Please call Alberta Health Benefits at 1-877-469-5437 if you need a
copy of your letter.
Refugee: Please provide a copy of any government document that confirms you are currently receiving support
under the Resettlement Assistance Program or Interim Federal Health Program.
587-896-3516
minds@ucalgary.ca
http://www.ucalgary.ca/mindsinmotion/
Additional Supporting Documentation:
1.
2.
3.
4.
5.
6.
Answers to open-ended questions within the Bursary Application Form. You may attach an additional sheet if there
is not enough room provided.
Letters from teachers or counselors.
Letters from shelters or other services for homeless.
Letters from social workers
Letters from Registered Recreational Therapists confirming that you have applied for AISH or Alberta Works
Programs.
Any other supporting financial documentation including rent/ mortgage slips, health care costs, etc.
Submitting the Application:
The application may be completed digitally by using Adobe Acrobat Reader. A digital signature is required in order to be
considered complete. Please send the completed application form to the Program Coordinator.
The application may also be completed by hand. A signature is required for this as well. Please mail the completed
application form to:
Minds in Motion
KNA 101, 2500 University Drive NW
Calgary, AB, Canada
T2N 1N4
If you have any questions, please do not hesitate to contact us at minds@ucalgary.ca
Sincerely,
Julia Sather
Minds in Motion Program Coordinator
T
E
W
587.896.3516
minds@ucalgary.ca
http://www.ucalgary.ca/mindsinmotion/
For office use ONLY
ID #__________ File # __________
Bursary Granted:  Yes  No
IF no, reason: ____________________
 FULL $____________________
 Partial $____________________
Camp Bursary Application 2014
Camper Information:
______________________________________
Last Name
First Name
____________________
Preferred Name
Sex:  Male
Date of Birth (year/month/day): _____/_____ /_____
 Female
________________________________________________________________________________________
Address – Number and Street
City
Province
Postal Code
Applicant Information (Parent / Guardian):
______________________________________
Last Name
First Name
___________________________
Email (primary contact method)
(____) - _____-______
Phone Number
Relationship to Child: ______________________________________
________________________________________________________________________________________
Address (if different from above)
City
Province
Postal Code
Financial Information:
Did your child receive a bursary in 2014?
 Yes
 No
Household Income from 2014:
$_____________
(Line 150 of your most recent Income Tax Assessment)
Number of People living in your household:
Adults (__) Children (__)
Bursary Amount you are applying for:  Full
 Partial
Parent Section:
Early Minds
Sky Science
1.
T
E
W
Engineering 101
Resource Rich Engineering
Natural Sciences
Girls Applied Science and
Engineering
Technology
Which Minds in Motion Program have you registered for (include grade)? ____________________________
Dates: _____________________
587.896.3516
minds@ucalgary.ca
http://www.ucalgary.ca/mindsinmotion/
2.
Why are you applying for this bursary?
3.
How will a Minds in Motion camp benefit your child?
Child Section:
What is your favourite part about science?
What do you hope to learn about at a Minds in Motion camp?
We recognize that a picture can be worth a thousand words! We left you some space if your child would like to answer the
above questions with a drawing instead or too!
Declaration:
I hereby declare that all information given above is true and complete in every respect; that I have
answered all questions on this form and that the bursary is essential to my child attending Minds in
Motion Camps. If my circumstances change from those reported on this application I agree to inform
Minds in Motion.
____________________________________________
Signature of Guardian/Parent
T
E
W
587.896.3516
minds@ucalgary.ca
http://www.ucalgary.ca/mindsinmotion/
_________________________________________
Date