TIMISKAMING FIRST NATION

Post-Secondary Financial Assistance Forms TFN EDUCATION 2014-05-01 TIMISKAMING FIRST NATION 0

Education Dept. Application Check List Please enclose the following when applying: Form: Statement of Intent p.2 Form: Financial Assistance p.3 to 6 Completed every two semesters (e.g: Fall 2014 and Winter 2015 and again for Fall 2015 and Winter 2016) Form: Signed Consent for release of information p.7 Completed yearly (Allowance will not be issued without this) Form: Special Funding p.8 Form: Student responsibilities p.9 Form: Change of Situation p.10 (very important if you withdraw or change programs) Forms To Be Sent In Personal birth certificate (it will be copied and original returned to you) Long form birth certificate for every dependent child and legal proof of guardianship Income tax or guardianship letter from Lawyer (they will be returned to you) No allowance will be provided until all documents are received Letter of Acceptance from a Post-Secondary Institution before beginning school otherwise funds will be withheld Transcripts (as soon as available) Fall Winter Spring Summer (All funds for the following semester will be withheld if not received in a reasonable amount of time or if any courses are unsuccessful (your name, the institution s name, the semester must all appear on your transcript) Proof of Official length of program of study with listing of courses from the institution Photocopy of your certificates, diplomas or degrees in your possession and as you obtain them Copy of Residency Contract (if applicable) Legible photocopy of your Indian Status Card (front and back) TIMISKAMING FIRST NATION 1

Education Dept. Statement of Intent When applying for any type of funding from the Timiskaming First Nation for postsecondary education, each applicant must complete this form. As a student, sponsored by the Timiskaming First Nation Post-Secondary Education Program, my intent is to Student s signature : Date : 2

24 Algonquin Avenue Notre-Dame-du-Nord, QC, J0Z 3B0 e-mail: allan.maclaren@atfn.ca Tel: 819-723-2335 Fax: 819-723-2353 FINANCIAL ASSISTANCE Post-Secondary Education DEMANDE D AIDE FINANCIERE Programme d aide aux étudiants du niveau post-secondaire TO BE COMPLETED EACH SCHOOL YEAR 20 to / à 20 PLEASE PRINT- en lettres moulées Tel: 819-723-2335 Fax: 819-723-2353 1. Name of student Nom de l étudiant 2. Date of Birth Date de naissance 3. Gender Sexe M F 4. Home address Adresse à domicile 5. Home Tel # - No. tél. ( maison) 6. Address (While Studying) Adresse (aux études) 7. Tel # while studying (no. de tel aux études) 8. Band Name Nom de la Bande Timiskaming First Nation 9. Status # - No d indien inscrit 064 10. Email Address (Mandatory) - Adresse courriel (Obligatoire) 10. # of dependents under 18 No. de personnes à charge moins de 18 ans 11. Marital status/état civil? Single/célibataire o Married/Common Law Marié (e)/conjoint de fait o EDUCATION PLAN PLAN D ÉTUDES 12. Full Time Part Time - Entrance Program Certificate Diploma Bachelor Master Full Doctorate 13. Field of study / Domaine d études 14. Institution Name Nom de l établissement and address 15. Program area / programme d études 16. Program code / code du programme 17. Length of program (Years) - Durée du programme (années) 18. Expected date of Graduation - Date prévue de diplomation / / / 19. Current year of study Année d études en cours 1 ᴏ 2 ᴏ 3 ᴏ 4 ᴏ Other/autre 20.. Effective Period: F Fall Winter Spring Summer Période: O Automne O Hiver O Printemps O Été 21. From Y-A / M / D-J TO Y-A / M / D-J DE: À 3

POST-SECONDARY STUDIES RECORD ÉTUDES POSTSECONDAIRES ANTÉRIEURES 22. Year Année Institution - Établissement Field and year of studies Domaine et année d etudes I hereby apply for financial assistance under the Post-Secondary Student Assistance Program for the period indicated. The above information is accurate to the best of my knowledge. I agree to provide proof of registration at the beginning of each term, send a copy of my results at the end of each semester and report any changes of my student status and/or program status within two weeks of the changes. I will provide a copy of my certificate/diploma/degree upon graduation. Par la présente, je soumets une demande d aide financière en vertu du Programme d aide aux étudiants du niveau postsecondaire pour la période indiquée. Les renseignements ci-dessus sont exacts. J accepte de fournir une preuve d inscription au début de chaque session, une copie de mes résultats à la fin de chacune de celle-ci, et de soumettre un avis de changement de mon statut d étudiant ou de mon Name programme d études dans un délai de deux semaines suivant ces changements. Une copie de mon certificat/diplôme sera envoyée à la réussite de mon programme. Print name / Nom (en lettres moulées) : Signature: Date: 4

Have you previously received assistance from TFN or other First Nation Post-Secondary Education Department? Avez-vous déjà reçu de l aide financière du département postsecondaire de TFN ou autre Première Nation? YES/OUI NO/NON REQUEST FOR FINANCIAL ASSISTANCE Post-Secondary Education 20 to 20 DEMANDE D AIDE FINANCIÈRE Programme d aide aux étudiants du niveau postsecondaire 20-20 If yes, please complete the following Box: Si oui, veuillez compléter la boîte suivante: Name/Nom of (du) College or (de) University Program of Study Programme d étude Dates (academic year/ année académique) Program Completed/completé? YES / NO Oui / Non FUNDING REQUESTED (see policy manual) everyone completes: FINANCEMENT REQUIS (voir guide) Tous doivent compléter : FUNDING/FINANCEMENT COST PER SEMESTER X # of sessions = Registration and/or tuition fees Frais d inscription et/ou de scolarité Books * Livres * Living Allowance Frais de subsistance Travel allowance Frais de voyage COUT PAR SESSION x # de sessions = $ x $ x $ x $ x GRAND TOTAL $ $ $ $ $ TOTAL COST COUT TOTAL *All original receipts for book purchases must be submitted to TFN within the first month of each term even if the amount does not total the advance. Over expenses will be reimbursed once original receipts are in. L étudiant doit soumettre tous ses reçus originaux à TFN à l intérieur du premier mois de chaque début de session même si le montant total ne dépasse pas l avance pour les livres. La différence sera remise avec les reçus. 5

Direct Deposit Bank Information Information pour dépôt direct Timiskaming First Nation The Education Department requests that students provide banking information for direct deposit of educational funds. Original blank cheque with void written across it is preferable or an authorization for direct deposit slip from your banking institution. Le département de l éducation demande que les étudiants fournissent leur information bancaire afin de profiter du dépôt direct. Un chèque avec la mention annulée dessus serait préférable ou une autorisation de la banque pour un dépôt direct. I certify that the information provided is correct. I understand that it is my responsibility to immediately inform Timiskaming First Nation Education Department, of any changes in regards to the information that I have provided. Failure to do so may jeopardize my present and future sponsorship. I understand that I will have to reimburse all funding if I do not abide by all the policies put in place. J atteste que l information est juste. Je comprends que je suis responsable pour informer immédiatement la Première Nation Timiskaming, département de l éducation, de tous changements qui pourraient survenir en regard de l information que j ai fournie. Ne pas le faire met en péril le parrainage dont je bénéficie maintenant et à l avenir. Je comprends que je dois rembourser tous les argents reçus si je ne respecte pas les politiques en vigueur. Student name (print) Date: Nom de l étudiant (en lettres moulées) Student s signature/signature de l étudiant: 6

Education Dept. Consent for Release of Information To: Office of the Registrar, Financial Services, Student Accounts, Student Records, Program Staff NAME: Student #: DIRECTION AND RELEASE: You are irrevocably authorized and directed to forward to the Post-Secondary Student Support Services Administrator, or Director of Education, or to whom the Education department may direct, the following documentation and information: Transcripts for each semester Attendance (where applicable) Notify the Education Department of Timiskaming First Nation of the student s status (courses added, dropped, withdrawal or exited from a course or the program of studies as soon as it occurs) Copies of diplomas or certificates as soon as available once the program is completed A scanned copy or photocopy or facsimile copy of this direction and authorization shall be as effective and valid as the original. Dated at, this day of, 20 The information requested is to be released to: TIMISKAMING FIRST NATION Education Department 24 Algonquin Ave. Notre-Dame du Nord, QC J0Z 3B0 FAX: 819-723-2353 e-mail: allan.mclaren@atfn.ca and c.c. to: Student s Signature: Witness name: (print_) Witness s signature: 7

Education Dept. Special Funding Form If extra funding is required, you must fill in this form and attach any document/letter that would support your request. We require that the funding request be submitted at least 3 weeks prior to the event. If it is an emergency situation, you should call the education department at the number listed above and ask to speak to the person responsible for the post-secondary files. Print Student s Name Student s Signature Date : 8

Education Dept. Student Responsibilities Student s Name: (Print) College/University: Program: Academic year: As a student being sponsored by the Timiskaming First Nation, I will follow the criteria prescribed in the Post-Secondary Education Policy by: 1. Representing Timiskaming First Nation in a positive holistic manner and I will adhere to the Timiskaming First Nation Post-Secondary Policy at all times. 2. Taking an active interest in my studies and I will perform to the best of my abilities. 3. Attending all classes on a regular basis. 4. Successfully completing my program of studies. 5. Submitting a copy of my registered class schedule to the Student Support Services Administrator at the beginning of each semester of study and notifying of any changes. 6. Submitting a transcript of marks to the Education Support Services Administrator at the end of each semester of study. 7. Provide my school e-mail address to the Education Department within two weeks of the start of school. 8. Send an -mail to the Education Department after mid-term and end of each semester to report on school progress. 9. Carefully read and comply with all conditions contained in the Timiskaming First Nation Policy. 10. Immediately notify Post-Secondary Student Support Services Administrator, in writing, of any program or course transfers, withdrawals or exits. Student s signature: Date: 9

Education Dept. Change in Situation As we go through life we can experience many changes. If you have a special event we need to know about, complete this form because it may change your funding status. For example, you may have a birth in your family that will correspond to receiving more funding while you are attending a post-secondary institution. If you withdraw from your program or change from studying full-time to part-time we need to know right away. Please complete this form should your situation change and forward it to the Timiskaming First Nation Education Department. Reason for Change Program Withdrawal Change in Program Status (Full-time to part-time or vice-versa) Child s Birth Other: EXPLAIN: Student s Name (print): Student s Signature: Date: 10