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SKILLS ENRICHMENT SCHOLARSHIP PROGRAM
REGISTRATION/TUITION & BOOKS/MATERIALS APPLICATION
Read the guideline pages attached before and while filling out your application. Incomplete, incorrectly completed applications will not be considered for funding. If you have any questions about this application form, contact the Foundation office at (306) 778-3314.
A. APPLICANT INFORMATION:
Address Line 2
Newfoundland and Labrador
Prince Edward Island
Social Insurance Number
B. PROGRAM/ COURSE/ CLASSES (this semester):
Have you been accepted to the Program?
Course / Class 1
Start Date 1
End Date 1
Course / Class 2
Start Date 2
End Date 2
Course / Class 3
Start Date 3
End Date 3
Number of credits completed:
(not including the ones you are applying for in this scholarship application)
Number credits needed to complete the course:
Tuition and Registration
Please enter a number from
Materials and Books
Please enter a number from
D. OTHER FUNDING (attach documentation/details relative to support received or support declined):
Amount Applied For
E. EDUCATIONAL BACKGROUND:
Certificate / Designation Achieved
Year Studies Were Completed or Discontinued
Other Courses or Training Completed
F. CAREER BACKGROUND:
Date Employment Commenced
Employer Phone Number
G. BENEFIT OF PROGRAM/ COURSE/ CLASSES:
MM slash DD slash YYYY
Attach all documentation files here
Drop files here or
Accepted file types: pdf, doc, docx, jpg, png, Max. file size: 5 MB, Max. files: 6.
I certify that the aforementioned information is true and correct.
I hereby authorize the Dr. Noble Irwin Regional Healthcare Foundation Inc. to validate any of the information related to this application.
If I am approved for a Skills Enrichment Scholarship, I hereby give my permission to the Dr. Noble Irwin Regional Healthcare Foundation Inc. to publish my name, place of residence & employment and the name of the program/course related to this application in written documents, publications or other type of media for purposes identifying approved applicants of the Skills Enrichment Scholarship Program, to be used to promote the Foundation and the Program.
By checking this box, you are digitally signing this application and are agreeing that all information provided is accurate and complete.
Consent to Share Information
WE the applicant gives the Dr. Noble Irwin Reginal Healthcare Foundation the right to share information with other funding agencies.
H. TO BE COMPLETED BY DEPARTMENT HEAD:
After completing this form, it will be emailed to YOU. Then you must have section H completed. Once that section is completed and signed, you can send it to the following: Dr. Noble Irwin Regional Healthcare Foundation Inc. Attention: SESP 2051 Saskatchewan Drive Swift Current, SK S9H 0X6
All Rights Reserved
Your ticket for the: Apply Scholarship