Current Form #PSSSP K-1: Post-Secondary Application for Assistance Form #PSSSP K-2: Consent to Request and Release Information Form #PSSSP L-1: Financial Assistance Agreement Form #PSSSP M-1: Probation Contract CompleteSection 1: Personal Information Legal Surname Given Names Date of Birth Preferred Pronoun (e.g., He, She, They) 10-Digit Band Number Home Address Have you been sponsored for post-secondary education by Chippewas of Georgina Island First Nation before? Yes No If yes, provide dates which you were sponsored (mm/yyyy to mm/yyyy) Email Address Cell Phone Alternate Phone (Optional) Emergency Contact Name Relationship to Emergency Contact Emergency Contact Telephone Section 2: Educational Plan Post-Secondary Institution You Plan to Attend (e.g., York University) Campus of the Institution You Plan to Attend (e.g., Barrie Campus) Name of Program You Plan to Enroll In (e.g., Business, Accounting) Program Start Date Tuition Payment Deadline Length of Program (e.g., 4 semesters, 8 semesters) Planned Date of Graduation Accreditation Upon Completion (e.g., Diploma, Degree, Master's/Doctoral degree) Will You Be Attending School Full-Time or Part-Time? Full-time Part-time Method of Delivery - Select -In-personOnlineDistance EducationBlended Is There a Co-operative Education (Co-op) Portion of the Program? Yes No If yes, what semester is the co-op and how long does it run? Do You Plan to Live in Residence? Yes No If yes, what is the residence deposit deadline? If no, what will be your living arrangement? (e.g., rental housing, living with family) Semester of the Program You Will Be Entering (e.g., 2nd, 3rd, 4th) Did You Successfully Complete Your Last Semester of School? Yes No Have You Previously Been Placed on Academic Probation Under CGIFN Post-Secondary Support Guidelines? Yes No If yes, please provide detailsSection 3: Personal Education Plan Personal Education Plan (500 words or less)Please describe your reasons for choosing your program and institution. Spelling and grammar matter. Your plan should include: A brief outline of the proposed program being considered.Why you are interested in the program. A list of the various institutions which offer the program. A rationale for attending the institution of choice and the length of time for completion. An indication of employment opportunities and future employment outlook. How your education will benefit the Chippewas of Georgina Island First Nation or Aboriginal people in general. The research steps taken to obtain this information.Continuing students will revise their Personal Education Plan annually and provide an outline of the academic standing achieved. Attach the Personal Education Plan to the application for continued funding along with a transcript of marks.Specifically on entering the final year of study, if there is any expectation of entering the next level of study it is to be highlighted on the Personal Education Plan.Section 4: Education Background Secondary Schools AttendedSecondary Schools Attended Dates (yyyy to yyyy) Name of Secondary School Address of School (City, Province) Diploma Date (attach a copy) Item weight Add Another Secondary School more items more items Upload Diplomas here Unlimited number of files can be uploaded to this field.64 MB limit.Allowed types: txt, rtf, odf, pdf, doc, docx, ppt, pptx, xls, xlsx. Post-Secondary Schools AttendedPost-Secondary Schools Attended Dates (yyyy to yyyy) Name of School Program Accreditation Achieved Item weight Add Another Post-Secondary School more items more itemsSection 5: Applicant's Declaration and Signature Estimated Tuition (per academic year) $ Estimated Living Allowance (per academic year) $ Estimated Books (per academic year) $ Total Amount of Financial Assistance Requested $I request financial assistance from Chippewas of Georgina Island First Nation to undertake my post-secondary studies in the amount of: I understand that it is my responsibility to opt out of any optional fees (e.g., health and/or dental). I understand that a condition of receiving funding is that I must provide proof of application for Ontario Student Assistance Program (OSAP). I have read and understand the CGIFN Post-Secondary Student Support Guidelines. 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 I will be required to sign a “Financial Assistance Agreement.” I understand that if I do not respect this condition, it may result in loss of eligibility for future Chippewas of Georgina Island First Nation funding. Signature of ApplicantI 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. Date 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 student's eligibility for the purposes of post-secondary funding under the Chippewas of Georgina Island First Nation Post-Secondary Student Support Guidelines. If you have questions, please contact CGIFN Student Services Coordinator. Void Cheque or Direct Deposit Authorization Form Please attach a void cheque or direct deposit authorization form.One file only.64 MB limit.Allowed types: pdf, jpg, jpeg, png.
