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PSE Assistance Program Application

The Confederacy of Mainland Mi'kmaq
Millbrook, NS

Détails du poste

Temps partiel | Temps plein

Compétences

Certificat collégial
Doctorat
Études postsecondaires
Maîtrise

Description complète du poste

ACADEMIC YEAR DATE RECEIVED BY CMM

TO BE COMPLETED AND RETURNED TO

THE CONFEDERACY OF MAINLAND MI’KMAQ
~ ANNAPOLIS VALLEY ~ BEAR RIVER ~ GLOOSCAP ~ PICTOU LANDING ~

MEMBER FIRST NATIONS

PO BOX 1590 TRURO, NOVA SCOTIA B2N 5V3 TEL: 902-895-6385 FAX: 902-893-1520

POST SECONDARY EDUCATION ASSISTANCE PROGRAM APPLICATION

~ IMPORTANT NOTES ~
BLANK SPACES ON THIS FORM WILL DELAY THE APPLICATION PROCESS

A LETTER OF ACCEPTANCE FROM THE UNIVERSITY / POST SECONDARY INSTITUTION & THE APPLICANT’S TRANSCRIPT
OF MARKS MUST ACCOMPANY THIS APPLICATION

[ ] RETURNING STUDENT [ ] NEW APPLICANT (MUST ALSO COMPLETE PAGE 2)

SURNAME: _____________________________________________ GIVEN NAME(s): _________________________________________

[ ] MALE [ ] FEMALE BAND: ________________________ BAND NO.: _________________ DOB:_________________________
[ ] NON-BINARY/TWO SPIRIT MM / DD / YY

PERMANENT ADDRESS: ________________________________ MAILING ADDRESS: ______________________________________

________________________________________________________ ________________________________________________________

POSTAL CODE: ___________ TEL: _______________________ POSTAL CODE: ___________ TEL: ________________________

[ ] MARRIED – IF SO, EMPLOYED SPOUSE? CANADIAN RESIDENT? USUAL PLACE OF RESIDENCE:
[ ] SINGLE [ ] YES [ ] YES [ ] ON RESERVE
[ ] OTHER [ ] NO [ ] NO [ ] OFF RESERVE

EMAIL ADDRESS: _______________________________________________________________________________________________________

NAME (s) AND AGE (s) OF DEPENDENT CHILD(REN) (IF ANY): ________________________________________________________
________________________________________________________ ________________________________________________________
________________________________________________________ ________________________________________________________

UNIVERSITY / POST SECONDARY INSTITUTION: ________________________________________________________________________

ADDRESS: _________________________________________________________________________ TEL: ____________________________

STUDENT ID: _______________________ NAME OF DEGREE / DIPLOMA / CERTIFICATE: _________________________________________

YEAR OF STUDY ENTERING (AS AT THE BEGINNING OF ACADEMIC YEAR APPLYING TO): __________ OF A _________ YEAR PROGRAM
1ST/ 2ND (1,2,3...)
EXPECTED YEAR OF GRADUATION: ________________________

CHECK ONE (1) LEVEL: CHECK ONE (1) STATUS: CHECK ONE (1) CATEGORY:

[ ] LEVEL I (COMMUNITY COLLEGE / CERTIFICATE PROGRAM [ ] FULL-TIME [ ] FALL
[ ] LEVEL II (UNIVERSITY UNDERGRADUATE / DEGREE) [ ] PART-TIME [ ] WINTER
[ ] LEVEL III (MASTERS / DOCTORATE) [ ] INTERCESSION
[ ] SUMMER

I hereby accept the responsibility of satisfying the academic / 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 further declare that the information contained herein is true
and correct. I also understand that approval of my application is based on the accuracy of the information I have provided, and neglect on my part to
immediately inform The Confederacy of Mainland Mi’kmaq of any changes to my file that may cause an overpayment, underpayment, or a significant
alteration will result in the immediate suspension or discontinuation of my funding.

________________________________________________________________________________ _________________________________
(SIGNATURE) STUDENT / APPLICANT DATE

FOR COMPLETION BY BAND EDUCATION COUNSELLOR

RECOMMENDED: [ ] YES [ ] NO COMMENTS: ________________________________________________________
_______________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________

________________________________________________________________________________ _________________________________
(SIGNATURE) BAND EDUCATION COUNSELLOR DATE

FOR CMM USE ONLY

APPROVED: [ ] YES [ ] NO COMMENTS:
________________________________________________________
_____________________________________________________________________________________________________________________
__

_____________________________________________________________________________________________________________________
__

________________________________________________________________________________
_________________________________
(SIGNATURE) EDUCATION ADVISOR, THE CONFEDERACY OF MAINLAND MI’KMAQ DATE

THE CONFEDERACY OF MAINLAND MI’KMAQ POST SECONDARY EDUCATION ASSISTANCE PROGRAM APPLICATION

PAGE 2

New applicants including graduate / and PhD students are required to provide us (below in writing) with an educational plan /
career goals and objectives (as per CMM Post Secondary Education Assistance Program Policy). In addition to this application
form and acceptance letter from the Post Secondary Institution, this plan is mandatory and must include the location of the
University / Post Secondary Institution the student is planning to attend, and how will this degree benefit your community. Also,
if the student has paid any application fees to programs identified in the plan, he/she is eligible for reimbursement. A COPY
OF YOUR STATUS CARD IS REQUIRED FOR ALL NEW APPLICANTS.

If required, Audriana Paul, Education Advisor, is available for assistance with this plan.

~ EDUCATIONAL PLAN / CAREER GOALS AND OBJECTIVES ~

_______________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________

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