PIIKANI NATION MEMBERS
Scholarships & Awards
Application form

Last Name
First Name
Piikani Membership # 436
Birthdate  ...
Gender
EMAIL Address
Mailing Address
City/Town
Prov.
Postal Code
Home Phone
Work Phone
Other
Would like to receive potential correspondence by mail?
Please fill in ONLY the portion that pertains to your 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 a scholarship/Award

SCHOLARSHIPS
Please indicate what level of education your scholarship pertains to:
Note: only applicants enrolled in or completing a FULL TIME program is eligible for a scholarship.
Institution
Name of Program
Program Start Date  ...
Program End Date  ...
AWARDS
1) Academic - Name of School:
Grade
2) Athletic - Sport:
Level/Division
Achievement
3) Piikani Language & Culture - Activity:
Age
Achievement
4) Literature & Fine Arts - Activity:
Age
Achievement
5) Leadership & Social Development - Activity:
Age
Achievement
6) High School Continuing Education Program - Post Secondary Institute:
Program
Start Date  ...
High School Graduate Incentive: - Post Secondary Institute:
Program
Start Date  ...
High School Attended
Date of Graduation  ...
Please note: Awards # 3 - 6 Applicants over the age of 18 must be submitted by nomination only.
Declaration of Applicant:
I agree, I will submit proof of participation and other required documents. I hereby verify that all the information I have provided on this form is correct to the best of my knowledge. I agree to consent that PYEF may verify the information as provided above with institution and or other agencies as may be required for statistical purposes and eligibility for a scholarship or award.
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