Part-Time Undergraduate Student Award Application Form

*Please Select the Term

Summer: May - August Deadline: April 1
Fall: September - December Deadline: August 15
Winter: January - April Deadline: December 1

Student #

*First Name

*Last Name

*Email Address

*Street Address

*City

*Province, Territory or State

*Country

*Postal Code

*Daytime Phone Number

Evening Phone Number

Age

Gender

Male Female

*Marital Status

Single Married/Common Law Separated Divorced

Number of Dependents under the age of 18

What are your dependents' ages

Citizenship

Visa Status

Student Permanent Resident

Have you resided in New Brunswick for the last 12 consecutive months

Yes No

Are you self-employed

Yes No

Present Occupation

Name of Employer

Employers Address

Spouses Occupation

Spouses Employer

*Are you admitted to a degree/certificate program by UNB

Yes No

If yes, please specify the program

Number of credit hours completed at UNB

Number of credit hours completed at another university

How many UNB courses do you plan to register in during this term? (Maximum of three)

One Two Three

Describe your educational or academic objectives in relation to your personal or career development

Most Recent Institution

Program

Dates

Diploma

Grade/Standing

Prior Institution #1

Program

Dates

Diploma

Grade/Standing

Prior Institution #2

Program

Dates

Diploma

Grade/Standing

Prior Institution #3

Program

Dates

Diploma

Grade/Standing

*During the previous 12 months, were you registered as a full-time student in a post-secondary institution

Yes No

Will you be registered as a part-time student at the University during the academic term in which you will hold the award

Yes No

Will you be residing in your parent's home during the academic term

Yes No

List other awards received for your academic work within the past year

Award 1

Award Date

Award 2

Award 2 Date

Describe your extracurricular activities, community involvement or personal interests

List your course expenses and income: (Fall applicants should include expenses for first term and full year courses. Winter applicants should include only the expenses for second term. Likewise Summer applicants should include only the expenses for the one appropriate term.)

To determine whether or not a student is in financial need, consideration is given to student’s income, number of dependents under the age of 18, partner’s income (if applicable), student loan and/or other pertinent financial details provided by the student.

Course Expenses

*Tuition

*Books & Materials

Transportation

Child Care

*Other

Sub Total

*Other Expenses Details

Income

*Your Expected Gross Income this year

*Spouses Expected Gross Income this year (if not applicable, enter 0)

*Other Awards / Allowances

Annual Support / Maintenance

*Payments Received

Savings

Other Source of Income

Sub Total

Income Details

Will you receive a subsidy or reimbursement of your course costs from an employer or other source

Yes No

If your income is low or nil, explain how living expenses have been met

Provide any additional details or information, which will clarify your financial need. If above figures do not adequately represent your circumstances, please elaborate briefly