Bursary Application Form

* Required fields

Your information

First name:

Last name:

My NorQuest student ID:

My NorQuest email address (MyMail):

Social Insurance Number:

Children accepted at 1000 Women Child Care Centre

First name:

Last name:

Date of birth:

Start date:

First name:

Last name:

Date of birth:

Start date:

Financial information

Marital status:

Single
Married or Common Law
Separated/Divorced/Widowed

Are you currently working:

Yes, Full-time
Yes, Part-time
No

If married/common law, is your spouse currently working:

Yes, Full-time
Yes, Part-time
No

Enter your income from line 150 of your most recent Notice of Assessment provided by Canada Revenue Agency:

Enter the income from your spouse’s line 150 of his/her most recent Notice of Assessment provided by Canada Revenue Agency:

Are you receiving the Alberta Child Care Subsidy:

Yes
No

If yes, amount of confirmed monthly subsidy being received:

Are you receiving any other form of child care subsidy:

Yes
No

If yes, indicate source:

Monthly subsidy being received:

Declaration and Consent

I hereby certify that the information on this form is complete and true in all aspects
I understand that the information collected on this application will be used to determine my eligibility for this bursary, and it will remain confidential
I understand that if it is determined that the information provided on this application is in any way incorrect or false, that:
- my application will be null and void and will not be included in the bursary selection process
- I will be liable for repayment to NorQuest College for any bursaries received due to false information given
I understand that if I withdraw, or am withdrawn from NorQuest College that I will no longer be eligible to receive the 1000 Women Child Care Bursary and I will be responsible for the full amount of child care fees.
I understand that if I am eligible for this bursary, that the bursary will be paid directly to Intercultural Child and Family Centre (operating the 1000 Women Child Care Centre) to supplement the parental portion of fees owing.

Applicant's Signature (Type your name):

Date:

Privacy notice statement

The NorQuest College Foundation operates as a charity to promote and provide educational services and assistance to the college. The privacy policy of the foundation is to be compliant with applicable portions of the Alberta Personal Information Protection Act (PIPA) and the Freedom of Information and Protection of Privacy Act (FOIP). The personal information collected on this form will be used to determine your eligibility for NorQuest College bursaries and will be used to comply with the federal Income Tax Act. For more information about the collection and use of this information, contact the Manager, Advancement Services, NorQuest College, Room A810, 10215 - 108 street NW, Edmonton, Alberta, AB T5J 1L6, Tel. 780.644.5926.

Application form

College Info

Campus Info

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Staff:

Bursary Application Form

Application form