Application – Kivalliq Inuit Association Student Sponsorship

    Kivalliq Inuit Association Student Sponsorship Application Form

    For a PDF version of this form please visit Here. or for the continuation form Here. Other wise please fill out the online version below.

    Please indicate below if this is a New KIA sponsorship Application or if you are currently being sponsored by KIA and are applying for Continuation of Sponsorship for the next academic year.

    Please Select what you are applying for:


    For More Information on what to select above, please click Here.

    PERSONAL INFORMATION

    Full Name:(as it appears in your ID)

    Social Insurance Number

    Permanent Mailing Address PO Box or street address:(Home, where your T4A will be sent to):

    Home Community:

    Province/Territory:

    Postal Code:

    Gender:

    Date of Birth:

    Social Insurance Number

    NTI Beneficiary Card Number:

    Work Phone Number:

    Fax Number:

    Drivers Licence Number:

    Diver's Licence Class Number:

    Email Address:

    Marital Status:

    Health Card Number:

    Citizenship:

    Have you ever declared Bankruptcy?:

    If "yes" give date of Absolute Discharge:

    Do you have an outstanding Canada Student Loan from any other source?:

    If Yes, From Where: Outstanding Amount:

    Have you previously applied for KIA Student Sponsorhip Program?:

    If "yes", When?:

    Preferred Languages of Communication: Are receiving disability benefits?: Are you or will be receiving Employment Insurance Benefits (EI)?: Are you or your spouse receiving income assistance payments?: If you will are receiving Income Assistance, you must inform your Income Support worker once you are approved for KIA funds. Will you be receiving salary or financial assistance from any other organization while attending school?:

    If "yes", from whom:(do not include scholarships)

    SCHOOL PROGRAM AND INFORMATION:

    Name Of School:

    Course Name:

    Course Start Date:

    Course End Date:

    Check one that applies to you:

    Course Location:

    School Mailing Address:

    City/Town:

    Province/Territory:

    Postal Code:

    Please Check One. Are you a resident of the Kivalliq Region? If Not How Long?:

    Number of Years:

    If you currently do not live in the Kivalliq Region then when was the last time?

    Date:

    Location:

    Are you going away from your home community for training?:

    Check one that applies to you. Status before training:

    Specify:

    SPOUSAL AND DEPENDENT INFORMATION:

    Note: You must immediately notify KIA if your spouse's employment situation changes.

    Your Spouse's Full Name:

    Your Spouse's SIN number:

    Your Spouse's Date of Birth:

    Is your spouse working?:

    If spouse working, include copy of VOI (PDF preferred):

    Is your spouse applying for sponsorship through Inuit Programs and Services as well?:

    If you have children together and both are applying for sponsorship then only one may claim for the child/ren.

    Will you be living with and supporting child/ren?:

    If you are claiming for the child/ren, please list them below

    Name:

    Date of Birth:

    Relationship:

    Health Card:

    Living with you? Y/N:

    if you need more space for more dependents enter here:

    PAST EDUCATION INFORMATION

    Last high school attended or currently attending:

    High School Name:

    High School Community:

    Highest Grade Completed and Year:

    High School Province/Territory:

    Post Secondary Education: (Last two programs,courses,training if applicable)

    Name of Institution:

    Program:

    Start Date:

    End Date:

    Did you complete the program:

    If not, please provide reason:

    Were you sponsored?:

    If yes, please name funding agency:

    Name of Institution:

    Program:

    Start Date:

    End Date:

    Did you complete the program:

    If not, please provide reason:

    Were you sponsored?:

    If yes, please name funding agency:

    Have you applied for FANS or ALTS for the course you are currently applying for? if Yes, please provide information on the other agency:

    Name of Agency:

    Have you ever been sponsored by our organization? If yes, please provide information:

    Program:

    Location:

    Year:

    Did you complete the program?:

    If no provide reason:

    EMPLOYMENT HISTORY

    Name of Current or Last Employer:

    What is, or was your Job Title:

    Employment Start Date:

    Employment End Date:

    Are you still working?:

    If not, please provide reason for leaving:

    Previous Employer

    Job Position:

    Start Date:

    End Date:

    Reason for Leaving:

    Job Position:

    Start Date:

    End Date:

    Reason for Leaving:

    Job Position:

    Start Date:

    End Date:

    Reason for Leaving:

    REQUIRED ATTACHMENTS

    Letter of Acceptance/Continuation from college/university:

    Confirmation of Funding:

    Letter of Interest/Intent:

    Copy of Resume:

    Copy of Transcripts of Previous Course/Program (or high school):

    Tuition and Texbook Costs (if fully sponsored by KIA):

    Copy of NTI Card:

    Copy of Void Cheque:

    DECLARATION AND SUBMISSION


    By signing this form and clicking on the submit button below, I swear that all of the information provided in this form and in the quotes are true and correct; if I am approved, I agree to provide receipts upon request by the Kivalliq Inuit Association; and that I believe this declaration to be true and know that it is the same as if made under oath.

    Please write your signature in the box below
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