Personal Information - Required
Last Name  
First Name  
Piikani Membership # 436  
Birth Date  
Gender  
Address  
Postal Code  
Home Phone  
Other Phone
Have you applied to Piikani Youth & Education Foundation in the past?  
If yes, for what?
Date of last application ...
Post Secondary Information
Adult Upgrading  
Trades/Technical  
College/University  
School Year  
Courses/Program  
Name of Institution  
Institution Address  
Length of Educational Training  
Identify the Degree, Diploma or certificate you will receive upon successful completion of the program  
Will you be funded by the Peigan Board of Education for the academic year?  
If yes, for the period beginning ...  
and ending ...  
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 documenation. 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 verifiy the information as provided above with other funding agencies as may be required for statistical purposes and eligibility for financial assistance.  
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