2017 LOCAL 1101 REGINA SCHOLARSHIP APPLICATION

Transcription

1 2017 LOCAL 1101 REGINA SCHOLARSHIP APPLICATION T be eligible applicants must be members/family members f Regina Lcal 1101 Public Service Sectr emplyees. Mail t: Attentin: Muna Deciman 35 Marsh Cres. Regina, SK S4S 5R3 LATE OR INCOMPLETE APPLICATIONS WILL BE REJECTED DEADLINE: JULY 31, 2017 Check ne: Full-time Studies Applicatin Part-time Studies Applicatin (3 r mre curses per semester) (Curses taken in 2017/18) Schlarship name: (Use a separate frm fr each schlarship) Name Mailing Address City/Twn Prv Pstal Cde / Telephne (Res) (Bus) Mailing address while attending schl: same as abve, r City/Twn Prv Pstal Cde / Telephne (Res) (Bus) I am submitting my applicatin fr an SGEU Schlarship and declare that the infrmatin given and statements made herein are true. I am including verificatin f enrllment alng with my cmpleted schlarship applicatin frm. I understand prf f attendance may be requested at anytime. Date 20 Signature f Applicant COMPLETE A OR B Prf f SGEU Membership Required (Phtcpy) A: IF YOU ARE AN SGEU MEMBER: B: IF YOU ARE A DEPENDANT OF AN SGEU MEMBER: Name Relatinship t Member Wrk Lcatin PS/GE Sectr/Lcal 1101 Regina Name f Member Lcal 1101 Member's Wrk Lcatin

2 NOTE TO APPLICANTS Please DO NOT include identifying infrmatin n pages 2 t 6 f the applicatin FINANCIAL INFORMATION: USE COLUMN A r B SGEU MEMBER APPLICANT Yur taxable incme fr 2016 Check ne $0 - $999 $60,000-69,999 $70,000-79,999 $80,000-89,999 $90,000 plus OFFICE USE ONLY Candidate Number M D FT PT $1,000-4,999 $5,000-9,999 $10,000-19,999 $20,000-29,999 $30,000-39,999 $40,000-49,999 $50,000-59,999 $60,000-69,999 $70,000-79,999 $80,000 $89,999 $90,00 plus Spuse's taxable incme fr 2016 Check ne Nt applicable $ $9,999 $10,000-19,999 $20,000-29,999 $30,000-39,999 $40,000-49,999 $50,000-59,999 DEPENDANT APPLICANT Yur taxable incme fr 2016 Check ne $0 - $9,999 $10,000-19,999 $20,000-29,999 $30,000-39,999 $40,000-49,999 $50,000 - plus Cmbined taxable incme f parents fr 2016 Check ne $ $9,999 $10,000-19,999 $20,000-29,999 $30,000-39,999 $40,000-49,999 $50,000-59,999 $60,000-69,999 $70,000-79,999 $80,000-89,999 $90,000 - plus

3 Self-Identificatin fr members f equity-seeking grups (Vluntary) I am a member f the fllwing equity-seeking grup(s): Check applicable bx(es) Abriginal Disabled Gay/Lesbian Wmen Visible Minrity Yuth MARITAL STATUS Single with 3 r mre Dependants Married/C-habitatin with 3 Dependants Single with 2 Dependants Married/C-habitatin with 2 Dependants Single with 1 Dependant Married/C-habitatin with 1 Dependant Single nly Married/C-habitatin N Dependants STATEMENT OF FINANCIAL FACTORS (Financial Need is a Primary Requirement) Applicants are nt eligible if they were awarded a schlarship in the previus 4 years. Indicate the barriers and special needs that apply t yur situatin: Living away frm hme during studies I am under 25 and a dependant f SGEU member. Mre than ne family member attending pst-secndary educatin I am emplyed at mre than ne jb. I have mre than 3 r mre dependants under the age f 18 years. (Ages f children). I am a primary care giver fr a persn with disabilities r elderly care prvider. DEGREE / CERTIFICATE PROGRAM I'm enrlled during as fllws: Institutin Name f Prgram

4 Student I.D. Number Degree r certificate sught Length f Prgram: Check ne Less than 1 year 1-2 yrs 3 yrs 4 yrs 5 yrs r mre Year f studies: check ne 1st 2nd 3rd 4th 5th Title f Curse(s) Hurs Start Date (dd/mm/yy) End Date (dd/mm/yy) Briefly state yur career gal(s) nce yu've achieved this curse certificate/degree ACADEMIC RECORD TO DATE Highest Grade Cmpleted Year cmpleted Degree / Certificate / Curse cmpleted t date Please attach a cpy f the transcript f yur marks applicable t yur mst recent educatinal histry frm yur previus schl. (If transcripts are unavailable, please prvide an explanatin.) 1. A few paragraphs in yur wn writing regarding yur participatin r yur families participatin in Unin Activities in Lcal 1101 Regina/r include why being a unin member is imprtant t yu in yur wn wrds and why yu deserve the schlarship

5 yu are applying fr. (i.e. years f service, attendance at meetings, elected psitins held, unin/cmmunity invlvement, etc.) 2. D yu plan t take a Leave f Absence frm yur current psitin in rder t attend these curses? If s will this be a leave "with" r "withut" pay? 3. Please list all dependents and their ages: 4. If yu are financially supprting dependents nt currently living with yu, please indicate them abve and prvide a brief explanatin f their relatinship t yu. CHECK LIST The fllwing is a check list f all dcuments required in yur applicatin package. Please assure all dcuments are included t ensure yu are cnsidered in the prcess. Transcripts Prf f enrllment Yur written Dcumentatin Cpy f Membership Card re: Unin Participatin Hw did yu hear abut this bursary prgram? Check ne r mre. SGEU website Schl Guidance Cunselr Schl display Steward Other-specify Chief Steward Parent Pster Saskatchewan Educatin Schlarship Directry SGEU Schlarship Directry Other directry - specify