Cambrian College In-Course Awards

2008-09 Application Form

Please include only one copy of any essays, letters of reference, transcripts, etc. with your application.

All information provided with this application is subject to verification by Cambrian College. The failure to
provide accurate information will disqualify the applicant from being considered for any awards listed.

The first use of any scholarship awarded shall be to pay tuition and/or residence fees to Cambrian College.

Applicant Information
Name Student Number
Email Address SIN Number

□ Female □ Canadian Citizen/Permanent Resident

□ Male □ International Student
Street Apartment
City Province Postal Code
Telephone

Have you been a resident of Ontario for the past 12 consecutive months? □ Yes □ No
Name of Cambrian Program
Current Year in Program Total Years in Program

Extra-Curricular Activities
Activities listed must include an official’s signature or a reference letter
Activity Specify organization Please print name of Official’s signature or Program
or activity official reference letter Requirement?
College Clubs &
Associations
Y N
Intramural Sports
Y N
Varsity Sports
Y N
Other College
Involvement Y N
Community
Involvement Y N
Peer Tutoring
Y N

Cambrian College In-Course Awards 1

Award List
Please list all of the scholarships, bursaries and awards that you would like to be considered
for. If you require additional space, please attach another page.

Award Number Award Name

Cambrian College In-Course Awards 2

Financial Information
Section A - Income for the study period (usually 8 months – September to April)
Employment income that you will receive during your Study Period. =$
OSAP that you will receive during your Study Period =$
Parental and/or spousal support that you will receive during your Study Period. =$
Bank loan and/or Line of Credit that you will receive during your Study Period. =$
Trust fund payment/RESP that you will receive during your Study Period. =$
Awards, bursaries and scholarships for the current Study Period =$
Personal Savings =$
Government Benefits Monthly Amount x Months in Study Period
Example $10 x 8 = $ 80
Employment Insurance x =$
Family Benefits x =$
Vocational Rehabilitation Services x =$
Workers’ Compensation x =$
Extended Care & Maintenance from Children’s Aid x =$
Aboriginal Student Support Program x =$
General Welfare x =$
Family Benefits for the Disabled (GAINS D) x =$
Other (specify):
x =$

TOTAL INCOME FOR THE STUDY PERIOD =$

Where are you living during the Study Period? With Parents Other

Section B - Expenses for the study period (usually 8 months – September to April)
Tuition and Compulsory Fees =$
Books/Program Supplies/Tools/Equipment =$
Residence/Rent/Mortgage =$
Travel to and from College (bus/gas/etc.) =$

Additional Expenses Monthly Amount x Months in Study Period

Example $10 x 8 = $ 80
Utilities x =$
Groceries/Meal Plan x =$
Phone/Internet x =$
Cable/Satellite x =$
Insurance x =$
Medical x =$
Loan Repayment x =$
Credit Cards x =$
Travel Home (Outside Sudbury) x =$
Day Care x =$
Restaurant/Entertainment x =$
Clothing x =$
Miscellaneous (laundry, household items, toiletries, etc.) x =$
Other (specify):
x =$

TOTAL EXPENSES FOR THE STUDY PERIOD =$

Cambrian College In-Course Awards 3

Applicant’s Consent to Release Information and Declaration
This confidential information will assist the Cambrian College Entrance Awards Selection
Committees in determining the applicant’s financial need.

I hereby authorize the Cambrian College Entrance Awards Selection Committees to have
access to my OSAP information for the purpose of award selection.

I hereby declare that the information I have submitted in this form is true and correct to the best
of my knowledge. I understand the failure to provide accurate information will disqualify me
from being considered for any awards.

Completion of this signed form permits the Awards Officer or a designate to access transcript
information and to permit members of the Selection Committee to view transcripts when
required.

I also understand that:

1) All information provided with this application is subject to verification by Cambrian
College; and
2) The first use of any scholarship awarded to me shall be to pay tuition and / or residence
fees to the College.

Furthermore, should I be granted an award, I agree to the release of my name, city of

residence, faculty / program and photograph for publicity purposes.

Signature Name (print) Date

Please send the completed application and all documents required to:

Awards Officer
Cambrian Foundation (Room 2609)
Cambrian College
1400 Barrydowne Rd.
Sudbury, ON
P3A 3V8

Deadline: November 28, 2008 @ 4:00 pm

For addition information, please contact the Cambrian Foundation at (705) 673-2900.

Cambrian College In-Course Awards 4