Bursaries & Grants - Individual

Personal Information - Required
Last Name:  
First Name:  
Piikani Membership # 436  
BIrthdate
Gender:  
Address:
Postal Code  
Home Ph:  
If yes, for what?
Other Ph:  
Have you applied to Piikani Youth & Education Foundation in the past?:  
Date: ...
Please fill in ONLY the portion that pertains to your sponsorship request.
See criteria for clarification OR call/visit our office for assistance.
ONE request per application form please - Incomplete Applications will not be considered for sponsorship.

A) EDUCATION SUPPORT
A.1) Extra Curricular & School Fees
School:
Address:
School Fees:
Grade:
OR Activity:
Activity Start Date: ...
Activity End Date: ...
Name of Activity:
School Contact Person:
TOTAL COST: $
A.2) Tutoring
Address:
Institution:
Name of Tutor:
Address:
Description of Tutoring:
Date of Tutoring Start: ...
Date of Tutoring End: ...
TOTAL COST: $

B) RECREATION & ATHLETIC SUPPORT
B. 1) Individual - Minor
Name of Program/Sport:
Address:
Start Date: ...
End Date: ...
Registration: $
TOTAL COST: $
B. 2) Individual - Intercollegiate
Institution:
Name of Program/Sport:
Address
Start Date: ...
End Date: ...
Registration: $
TOTAL COST: $

C) PIIKANI LANGUAGE & CULTURE
Name of Program:
Address:
Start Date: ...
End Date: ...
Registration: $
Materials: $
TOTAL COST: $

D) LITERATURE & FINE ARTS
Name of Program:
Address:
Start Date: ...
End Date: ...
Registration: $
Materials: $
TOTAL COST: $

E) LEADERSHIP & ENTREPRENEURIAL DEVELOPMENT
Name of Program:
Address:
Start Date: ...
End Date: ...
TOTAL COST: $

F) SOCIAL & PERSONAL DEVELOPMENT
Name of Program
Address
Start Date ...
End Date ...
TOTAL COST: $

G) GRADUATION GRANT
Program Completed:
School/Institution:
Highschool Diploma:
Certificate:
Diploma:
Undergraduate Degree:
Graduate Degree:
Trade:
Date of Completion: ...
Declaration of Applicant
I agree, if approved for financial assistance, to comply with all the policies, rules and regulations of Piikani Youth & Education Foundation. For funding request purposes I will be required to submit proof of participation, transcripts and other required documents as required. I am also aware that I may be ineligible for future funding should I fail to submit required documentation. I hereby verify that all the information that I have provided on this form is correct to the best of my knowledge and that no relevant information has been withheld. I agree to consent that PYEF may verify the information as provided above with other funding agencies as may be required for statistical purposes and eligibility for financial assistance.
Date: ...
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