Red Pheasant Cont Spring/summer application

Red Pheasant Post Secondary
P.O. Box 7
Cando, Saskatchewan
S0K 0V0
Telephone: (306) 937-7012 Fax: (306) 937-7032
CONTINUING APPLICATION – Spring /Summer Intersession
Due: February 28

Check one of the following:*
- FULL TIME
- PART TIME
Name*
Surname First Name Initial
TREATY #:*
Full ten-digit number
DATE OF BIRTH:

Day/Month/Year
ADDRESS:*
Apartment #/Street #/or P.O. Box # Town/City Province/State Postal Code/Zip Country
PHONE:*
EMAIL:

1 - Name
DEPENDANT CHILDREN NAME AGE SCHOOL ATTENDING CITY/TOWN
2
DEPENDANT CHILDREN NAME AGE SCHOOL ATTENDING CITY/TOWN
3
DEPENDANT CHILDREN NAME AGE SCHOOL ATTENDING CITY/TOWN
4
DEPENDANT CHILDREN NAME AGE SCHOOL ATTENDING CITY/TOWN
(If you need more space, attach another sheet with the required information to the application)

**ACCORDING TO THE POLICY MANUAL, STUDENTS WHO MISREPRESENT THEIR DEPENDANT OR ACADEMIC STATUS WILL HAVE THEIR FUNDING TERMINATED**
IN THE EVENT THAT YOU CANNOT BE REACHED AT YOUR RESIDENCE, LEAVE NAME & NUMBER WHERE A MESSAGE MAY BE LEFT FOR YOU.
NEXT OF KIN NAME:*
Telephone*

INSTITUTION ATTENDING:
INSTITUTE ATTENDING:*
COURSE/PROGRAM:*
*
TOTAL CREDITS THIS YEAR: THIS TERM:
YOUR FINAL REGISTRATION FOR NEXT TERM MUST BE IN THE OFFICE BY March 31st,*
TERM I TRANSCRIPTS MUST BE FORWORDED WHEN THE TERM, IN PROGRESS, IS COMPLETED. NO SPONSORSHIP LETTERS WILL BE SENT TO INSTITUTION UNTIL ALL DOCUMENTATION IS RECEIVED.
I CERTIFY THAT ALL THE ABOVE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS CORRECT AND COMPLETE, AND THAT NO RELEVENT INFORMATION HAS BEEN WITHHELD OR FALSIFIED. I UNDERSTAND THAT MISREPRESENTATION, FALSIFICATION OF DOCUMENTS, OR WITHHOLDING OF REQUESTED INFORMATION, IN REGARD TO THIS APPLICATION MAY RESULT IN AN IMMEDIATE CANCELLATION OF MY APPLICATION. I, ALSO, AGREE TO ABIDE BY THE POLICIES SET OUT BY THE RED PHEASANT EDUCATION AUTHORITY INC., IN REGARD TO POST SECONDARY STUDENTS.
SIGNATURE
DATE
The information you provided on this document is for the purpose of resource and administering post secondary financial assistance. Personal information that you provide is protected under the provision of the PRIVACY ACT. The information you provide on this document is for the purpose of resource and administering post secondary financial assistance. Personal information that you provide is protected under the provision of the PRIVACY ACT.

I hereby authorize that all information concerning my academics may be released upon request to RED PHEASANT POST SECONDARY:

1. Pertaining to my program/course registration
2. Pertaining to my financial obligations
3. Pertaining to my attendance
4. Pertaining to my academic progress and/or related information
STUDENT’S NAME (Please Print):*
STUDENT’S SIGNATURE:*
DATE*
INSTITUTION:*
TERM:*
STUDENT NUMBER:*
THIS CONSENT TO RELEASE INFORMATION CONTAINED HEREIN IS IN EFFECT FOR THE TERM SPECIFIED, AND MUST BE RESUBMITTED FOR EACH TERM.
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