Confidential
1.
2.
SECTION 1
School Year
Applicant’s
Last Name
Local Home
Address
City
1
20__
First Name
Province
11. Personal Status
Postal Code
Home Phone
E-mail Address
3. Place of Birth
4. Courses or Program
Cell Phone
Date of Birth (Mo/Da/Yr)
5.
6.
Name of University, College, School or Association which offers this Course or Program
Address of Registrar
City Province Postal Code
7.
Length of Education/ Training Period
(choose one)
(a) Secondary School Education
(b) Mature Student 2
Years Months Weeks
8. Registered Year (choose one)
9.
1 st 2 nd
Identify the Degree, Diploma or Certificate you will receive upon successful completion of the program
3 rd 4 th
10. Basic education level or training level, which provides for your admission to this Course or Program
Year
(c) Other (explain giving details)
Single
Married
Divorced
Single Parent
Widow(er)
Other (Specify)
Number of Dependants (if applicable)
1
2
Please Print
One who has been out of school for one or more Years
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12. Estimated Expenses for Academic/Vocational Year ($)
Total tuition fee per year
Books
Tools/Instruments 3
Residence/Room & Board
Transportation
Other (Specify)
13. Financial Resources
(a) Have you received training/employment benefits in the current year?
Yes No If yes, amount ($)
For the Period (Mo/Da/Yr) Beginning Ending
(b) Scholarships received
(c) Bursaries received
Name
Name
Name
Name
Name
Amount ($)
Amount ($)
Amount ($)
Amount ($)
Amount ($)
(d) Employment in past year
If yes, amount earned ($)
Yes
14.
(a) Total combined income of parents/guardians for the previous year
(from all sources unless you are a mature student) ($)
(b) Number of ‘Other’ dependants residing at home
(c) Number of ‘Other’ dependent children attending a Post-Secondary
School of Education
(d) Student’s Total Assets (Bonds, Securities, Cash in Bank, et cetera ) ($)
(e) Total combined income of applicant & spouse, if a married student ($)
15. Additional information related to this application which you feel is important.
No
3 Apprentices only
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16.
(a) I hereby promise to return pro rata portion of this Bursary if I quit or am suspended prior to the end of the semester/year end (illness may be an exception).
Signature of applicant
Date (Mo/Da/Yr)
(b) I hereby authorize the Bursary Committee to obtain information concerning any other monetary assistance received
Signature of applicant
Date (Mo/Da/Yr)
(c) I hereby indicate and do promise the aforementioned information regarding my finance and education to be true to the best of my knowledge, realizing any false information may be considered fraudulent
Signature of applicant
Date (Mo/Da/Yr)
Signature of parent/guardian (as applicable)
Date (Mo/Da/Yr)
Legion Member History
Veteran Information – Applicable to the Dependents of Ex-Service Personnel (Legion Member)
Attach a Photocopy of Service Papers to Application
SECTION 2
Name of Applicant
Name of Parent/Guardian
Address of Parent/Guardian
City/Town
Home Phone
Name of Ex Service Person
Relationship to Applicant
Province
Cell Phone
Postal Code
Military Service Number
Period of Service (Mo/Da/Yr)
Deceased
From
Yes
Unit
To
No
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Membership in Branch or Ladies Auxiliary to be verified at Branch Level
SECTION 3
Check one of the following
War Veteran
Ordinary/Life Member
Associate Member
Affiliate – Voting Member
Ladies Auxiliary
Name of Applicant
Relationship of Applicant to Branch Member
Name of Parent/Guardian
Member of Branch No. ____
Branch Address
City/Town
Verification by Branch or L.A. Secretary
Ladies Auxiliary
Province Postal Code
I certify that ______________________________________ is a member of Branch No. ____, in good standing for
_____years.
Signature of Branch or Ladies Auxiliary Secretary
Date (Mo/Da/Yr)
Proof of Enrolment
Application to be completed prior to submission to the Registrar at the
University/Community College for their endorsement.
Proof of Enrolment must be shown and endorsed by the Registrar
School Seal must be applied to this application
SECTION 4
Authorized Signature
Title
Date (Mo/Da/Yr)
4

Date (Mo/Da/Yr)
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For Branch Use Only
SECTION 5
Vocational or Apprentice Committee Endorsement
Dated at
Date (Mo/Da/Yr)
Authorized Signature
Title
Branch 76 Bursary Chairman
School Year
Bursary Approved Yes No
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