Post Secondary Assistance Post Secondary Education Assistance Program Application DEADLINE: JUNE 15TH – ACADEMIC YEAR To be completed and returned to The Confederacy of Mainland Mi’kmaq – Post Secondary Education Assistance Program. Student Status* Returning studentNew applicant Personal Information Surname* Given Name(s)* Gender* MaleFemaleNon-binary / Two-Spirit Band* Band Number* Date of Birth* (MM / DD / YY) Contact Information Permanent Address* Permanent Postal Code* Permanent Telephone* Mailing Address (if different from permanent) Mailing Postal Code Mailing Telephone Email Address* Marital / Residence Information Marital Status* SingleMarriedOther Is spouse employed? YesNoNot applicable Is the student a Canadian resident? YesNo Usual place of residence* On reserveOff reserve Dependent Children (if any) Names and ages of dependent child(ren) Post Secondary Institution Information University / Post Secondary Institution* Institution Address* Institution Telephone* Student ID (if known) Name of Degree / Diploma / Certificate* Year of study entering* (e.g. 1 of 4-year program) Expected year of graduation* Program Details Level of study* Level I (Community College / Certificate)Level II (University Undergraduate / Degree)Level III (Masters / Doctorate) Status* Full-timePart-time Category / Term* FallWinterIntercessionSummer Educational Plan / Career Goals and Objectives New applicants (including graduate and PhD students) are required to provide an educational plan, outlining career goals, the location of the institution, and how this degree will benefit your community. Educational Plan / Career Goals and Objectives* Declarations & Consent By submitting this application, I accept the responsibility of satisfying the academic and training requirements of the Post Secondary Institution and the funding organization and agree to manage the Education Assistance funds in a reasonable and responsible manner. I declare that the information provided is true and correct. I understand that approval of my application is based on the accuracy of this information and that failure to immediately inform The Confederacy of Mainland Mi’kmaq of any changes that may affect my funding may result in suspension or discontinuation of funding. I have read and agree to the declaration above* Date*
