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Athabasca Chipewyan First Nation            Education Grant Application
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ACFN Education Grant Policy - Please read prior to completing application questions below.
Name of Student/Member *
Address *
Email Address *
Home phone number
Work phone number
Cell phone number
Treaty Number *
What is your age? *
Have you received an education grant from ACFN in the past? *
If you have received an education grant in the past, please provide the year of the grant and the program and institution.
If you received an ACFN education grant in the past, did you complete the program for which the grant was provided?
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What year did you graduate from high school? *
What is the total amount of the grant applied for? *
What is the grant for? Fill in the amount for each category.
Tuition $ amount *
Books $ amount *
Living Expenses $ amount
Describe any other sources of funds you will be using to pay for your education including personal savings, grants from other organizations, awards or bursaries.
Source and Amount
What is the name of the educational institute you will be attending?

 *
What is the course of study or program you are enrolled in?

 *
What is the normal time required to complete the program of study (for example a typical university degree is normally completed in four years)

 *
Indicate what year of study you are enrolled in (example 2nd year out of 4 years) *
Are you studying full time or part time? *
What is the start date? *
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What is the end date

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Have you ever withdrawn from or failed to maintain academic standard in a course of study? *
If you answered yes to the above, please provide details
Please describe your long term career plan and how the course of study you are undertaking will help you attain your goals. *
In what way would you education enable you to contribute back to ACFN? (eg, resources for other students, become a doctor for our community, work for an ACFN company, become a vet) *
Have you been sponsored by ATC in the past? *
If the answer to the above was yes, what year?
If the answer to the above was yes, what program did you take?

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If the answer to the above was yes, were you successful in completing it?
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If you have dependents, please provide their names and dates of birth
Do you have a dependent spouse as defined in the Education Grant Policy?
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What is your dependent spouse's name?
If you have a dependent spouse, please provide the details of the diagnosed medical reason why your spouse is unable to work in any gainful occupation
Have you read the Education Grant Policy and accept the terms and conditions upon which the grants are made? *
NOTICE: The Education Coordinator may require additional information to process your request for a Grant. If so, you will be contacted and must provide the information or documentation to maintain your application.
Date of application *
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Declaration *
ACFN Student Funding Contract - Please read before completing questions below
Acknowledgement *
Required
Date *
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Statement of Intent - Please read before completing below.
Student Name *
Institution *
Program *
Program Length *
Why have you selected this program?  *
What are your future goals and job prospects? *
Acknowledgement *
Required
Date *
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Please read and submit void cheque as indicated below.
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Submit
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