Date of Application: ___________________ Student Months Used: _____________________

Full Time:__ Part Time: __ Academic Year: ____________

Spring: __ Summer: __ Fall: __ Winter: __ Student ID#: _______________

Institution: __________________________________________________

Address: ___________________________________________________

Personal Information

1. Name: ____________________ 2. Former Name: ____________________

3. Student Address: _______________________________________________________________
Permanent Address: _______________________________________________________________

Telephone: _______________ Message: _______________

4. Registry #: _______________ 5. Male: __ Female: __

6. Date of Birth: _______________

7. Single: __ Single Parent: __ Married/Common Law: __
Is your spouse employed? Yes No

8. Number of Dependent Children: __________

9. Please List Your Dependent Children if Applicable (please include name and date of birth):

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

10. Next of Kin: _______________________________ Telephone: _________________

Previous Education and Training

11. Please offer information regarding your elementary and secondary schooling and, as well, any post secondary training/education you may have undertaken.

School Name: _______________________Location: _______________________Year Completed:__

Program Completed:________________________Certificate/Degree:__________________________

Elementary: ______________________________

Secondary: ______________________________

Post Secondary: _____________________________

Present Education Goals

12. Name/Address of Post Secondary Institution You Wish To Attend: ________________________
______________________________________________________________________________
______________________________________________________________________________

Course/Program: ________________________________

Year - Prep: __1 __2 __3 __4 __ Grad: __

Program Length:________________________________

Funding Period - Start Date: __________ End Date: __________

13.(Fill out only if you are a first-year student or if your goals have changed since your last application.)
Briefly describe both your short-term and long-term educational goals, indicate clearly the importance of the course/program you wish to attend. Use separate paper and attach to form. Please write neatly and clearly.

Student Signature: ____________________________________ Date: _________________________

I understand the following condition for sponsorship by Key First Nation for post secondary studies:

1. I will accept the responsibility to adhere to the school regulations and meet the standards required by the school for continuation in my course of studies.

2. I agree to attend classes regularly.

3. I agree to consult with a counselor if any problems arise academically, emotionally, physically and financially.

4. I agree to provide my marks and reports on a semester-by-semester basis to the Key First Nation and/or upon Key First Nation's request.

5. I agree to report any changes to my student and/or program status promptly. I understand that it is a serious matter to provide false information and/or fail to report any change in the information provided.

6. I authorize the Key First Nation to obtain information from persons, agencies, or organizations to determine and/or verify my eligibility for benefits or services under the Post Secondary Student Assistance Program.

7. I declare that all of the information provided is true and complete and I make this solemn declaration believing it to be true and knowing that it is of the same force and effect as if made under oath.

8. I understand that I have the right to appeal any decision made with respect to my application for sponsorship.

I hereby agree to the terms/conditions for financial assistance that I have read above.

Student Signature: ____________________ Date: ______________

Spouse Signature: ____________________ Date: ______________

I hereby agree as a sponsor to provide moral support and encouragement that may be needed by this student to complete his/her studies.

Sponsor Signature (optional): ____________________ Date: ___________