MYRNA FIRMAN MEMORIAL BURSARY
APPLICATION
DEADLINE: March 31, 2015 4:30 p.m.
2 Awards at $500
Eligibility Criteria:
To be eligible to receive the Myrna Firman Memorial Bursary, a student must:

Apply for the bursary

Be enrolled in the Language Instruction for Newcomers to Canada program at Saskatoon Campus

Have Immigrant or Refugee status in Canada

Not currently in receipt of government sponsorship funding (e.g., church sponsored, privately
sponsored or no longer receiving government sponsorship funds)
Selection Criteria:
Selection will be based on:
 Financial need - 75% weighting
 Career goals - 25% weighting
Preference will be given to students whose children reside with them in Canada.
PERSONAL INFORMATION – MUST PROVIDE ALL INFORMATION
Last Name
First Name
Student ID Number
Mailing Address
City/Province
Postal Code
Phone number:
Email:
Cell number:
Do you have children who reside with you in Canada?
Yes or No
CAREER GOALS
1.
2.
3.
4.
Conditions of Acceptance
Information is collected under the authority of The Local Authority Freedom of Information and Protection of Privacy Act, Section 28(2)(a). I
hereby allow this information to be used in whole or in part and agree that it may be reproduced and published. It will be used for the purposes
of award selection and administration and will be shared with selection committee members. This personal information may also be used for
administrative and statistical purposes by Saskatchewan Polytechnic and/or provincial or federal government ministries and agencies. If selected,
recipients’ names, program of study, may be disclosed to the donor of the award, and published in Saskatchewan Polytechnic’s awards programs,
and/or used in other media outlets or Saskatchewan Polytechnic publications. Recipients will be required to give permission to Saskatchewan
Polytechnic to provide their contact information to the donor of the award if requested by the donor.
 I have read and agree to the Conditions of Acceptance.
 I declare that the information I have given is true and reflects an accurate summary of my financial information and that I
have answered all questions applicable to me.
 If at any time I no longer meet award criteria, due to withdrawal or other reasons, payment will be withheld. I understand
that the values and availability of awards, policies and procedures regarding that administration of awards may change at
the Donor’s or Saskatchewan Polytechnic’s discretion.
Signature of Student: ____________________________________ Date: ________________________
By applying for awards, students consent to the use and disclosure of their personal information as described above. If you
have any questions or concerns about the collection or disclosure of this personal information, contact Amanda Robinson at
306-775-7716
Amanda Robinson
Donor and Alumni Relations
Regina Campus
4500 Wascana Parkway
Regina SK S4P 3A3
Phone: 306-775-7716 Fax: 306-775-7793 [email protected]