Red Pheasant post Sec Fall App – Clifford Wuttunee School

APPLICATION FOR CONTINUING STUDENTS (FALL TERM)

Date Received:*
RED PHEASANT POST SECONDARY
P.O. BOX 7
CANDO, SASKATCHEWAN
SOK 0V0
TELEPHONE: (306) 937-7012 FAX: (306) 937-7032
APPLICATION FOR CONTINUING STUDENTS (FALL TERM)
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Below is some general policy information that is important for you to keep in mind while you are completing your application. If you have any questions or need assistance please do not hesitate to contact our office.
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1) Continuing applications must include the following documentation :
a) Dependent verification (COPY OF REVENUE CANADA – Child Tax Benefit)
b) Final registration for applicable term
c) Class tracking sheet
d) Most recent official transcripts of marks
e) A signed waiver of access for submission to the institute of learning that the applicant will be attending.
f) Direct deposit form (only if banking info has changed)
6) APPLICATION DEADLINE DATES:

FALL (SEPTEMBER ENROLLMENT) ------ APRIL 30

(1) Continuing students
(2) New applicants if funds are available

WINTER (JANUARY ENROLLMENT) ------ OCTOBER 31

(1) Continuing students
(2) New applicants if funds are available

INTERCESSION / SUMMER SCHOOL ------ MARCH 30

(1) Continuing students only

6) POST SECONDARY EDUCATIONAL ASSISTANCE:
CHECK ONE OF THE FOLLOWING:*
- FULL-TIME:
- PART-TIME:
1: Name*
Surname First Middle Initial
TREATY #:*
Full 10 digits
D.O.B:
2: Address
Apartment # / Street no. / Box no. City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
3:
DEPENDENT CHILDREN SCHOOL ATTENDING CITY/TOWN
1:
NAME AGE
2:
NAME AGE
3:
NAME AGE
4:
NAME AGE
5:
NAME AGE
6:
NAME AGE
(If you need more space, attach another sheet with the required information to the application)
**ACCORDING TO THE POLICY MANUAL, STUDENTS WHO MISREPRESENT THEIR DEPENDENT OR ACADEMIC STATUS WILL HAVE THEIR FUNDING TERMINATED **

IN THE EVENT THAT YOU CANNOT BE REACHED AT YOUR RESIDENCE, LEAVE YOUR NAME AND NUMBER WHERE YOU A MESSAGE MAY BE LEFT FOR YOU.
4: NEXT OF KIN:*
Surname First Middle Initial
Address*
Apartment no. / Street no. / Box no. City State / Province / Region ZIP / Postal Code Country
Phone*

STUDENTS ARE REQUIRED TO SIGN THE RELEASE FORM IN ORDER FOR THE APPLICATION TO BE PROCESSED, FAILURE TO DO SO MAY DELAY OR DISQUALIFY THE APPLICATION
6. STUDENT’S RELEASE OF AUTHORIZATION: TO BE SENT TO INSTITUTE

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:*
TERM:*
STUDENT #:*
INSTITUTION:*
THIS CONSENT TO RELEASE INFORMATION CONTAINED HEREIN IS IN EFFECT FOR THE TERM SPECIFIED, AND MUST BE RESUBMITTED AFTER EACH TERM.

DIRECT DEPOSIT
*(MUST BE COMPLETED BY BANK)
** Direct deposit is available to residents with Canadian Accounts only **
NAME:*
ADDRESS:*
Apartment no. / Street no. / Box no. Town / City Province / State Postal / Zip Code

TELEPHONE:*
NAME AND ADDRESS OF BANK:
Street Address Address Line 2

BANK TELEPHONE:*
BANK TRANSIT NUMBER: (must be 5 digits)*
STUDENT ACCOUNT NUMBER:*
TYPE OF ACCOUNT:*
savings Accounts
chequing Accounts
ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL,
PLEASE PROVIDE ALL THE REQUIRED INFORMATION. CHECK WITH YOUR BANK SO THAT THE INFORMATION IS ACCURATE TO ENSURE WE GET YOUR MONEY TO YOU ON TIME. INCOMPLETE OR INCORRECT INFORMATION CAUSES DELAYS.
IF YOU HAVE A CHEQUING ACCOUNT, PLEASE SUBMIT A BLANK VOID CHEQUE TO OUR OFFICE IT WILL PROVIDE ALL THE NECESSARY INFORMATION WE NEED.

I HEREBY AUTHORIZE RED PHEASANT POST SECONDARY TO DIRECTLY DEPOSIT INTO MY BANK ACCOUNT AS NOTED ABOVE.
Signature*
Date*

CAPTCHA
*ONLY COMPLETE IF BANKING INFORMATION HAS CHANGED FROM THE INFORMATION ON FILE!!

Surname	First	Middle Initial

Surname	First	Middle Initial

APPLICATION FOR CONTINUING STUDENTS (FALL TERM)

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