Education
For Life Bursary Application Form
(If you require additional space, please use another
sheet of paper. All submissions will be kept strictly confidential)
Date: ______________________
Name ___________________________________________________________
Address _________________________________________________________
City ____________________________
Postal Code ___________________
Phone ( ) _________________ Fax (
) ___________________________
E-Mail ________________________ Date of Birth
(D/M/Y) ______________
Do you have a disability?_________ Social Insurance Number_______________
Is this your first year of post-secondary education? If not, how
many years have you completed previously?___________________
Are you currently a member of ACCD? If not, have you included
your membership with the application package?________________
Name and address of educational institution you wish to attend. Please
enclose evidence/proof of acceptance.
________________________________________________________________
________________________________________________________________
What is your proposed course of study?
________________________________________________________________
Breakdown of your total educational costs for the year:
Tuition / Fees: $__________ Books: $____________
Other fees: ___________
Breakdown the costs of the course you would like us to help fund:
If taking multiple courses please select the one you would like us
to fund.
Name of Course: ____________________________
Tuition / Fees: $__________ Books: $____________
Other fees: ___________
How do you expect to finance your education?
________________________________________________________________
Explain what your educational goals are, what you want to accomplish with
the education/training you will receive, and how it will enhance your life.
(Use a separate sheet if more space is needed.)
________________________________________________________________
________________________________________________________________
________________________________________________________________
In order to be eligible to receive this bursary, your application
form must be completed in full and must be accompanied by the
following:
- Proof (letter, calendar information) from the educational
institution verifying the cost of course materials and tuition
fees.
- ONE reference letter from an adult other than a family
member. Note: Only one reference letter will be considered.
- A brief biography (max 200 words).
- Applicant must become a member of ACCD by the application
deadline.
- All application materials must be received at the ACCD office
by JUNE 30 the year you apply.
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