SpencerCreo Bursary Application Form | Family Services of Greater Vancouver

Applicant Personal Information
First Name*
Last Name*
Date of Birth*
Date Format: MM slash DD slash YYYY
Social Insurance Number*
Phone Number*
Email*
Street Address*
City*
Postal Code*
Marital Status*
Please choose one of the following options
Employment Status*
Please choose one of the following options
Legal Status*
- Permanent Resident
- Canadian Citizen
Number of Dependents*
Housing Accomodation*
- Shared Housing
- Live with Parents
- Rent
Highest Level of education achieved:*
Tell us about your situation; the barriers you have faced to education and employment, and the impact this award will have for you.*
What are your desired outcomes from education?*
Once your education is complete, what job prospects are there and at what wage range? Will this help you reach economic stability? (please refer to your WorkBC Work Plan)*
Please provide a detailed support plan (with your social worker, case worker or counselor) that will help you achieve educational and employment success.*
Labour Market Consultation
You must complete a Labour Market Consultation with WorkBC (or equivalent public or private expert labour market agency) Please attach documentation with this application.
File*

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Applicant Academic Program Information
Name of School & Address*
Name of Program*
Program Length*
Program Start Date*
Date Format: MM slash DD slash YYYY
Program End Date*
Date Format: MM slash DD slash YYYY
Final Acceptance Date*
Date Format: MM slash DD slash YYYY
Registration Date*
Date Format: MM slash DD slash YYYY
Complete Schedule A (Academic Program Information)
Please ensure to provide academic program details for each of the school terms and semesters. Use additional pages if necessary
File

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Employment

Name of Employer	Hourly Wage	Average Number of Hours Per Week

Other Source(s)

Income received for this academic term - bursaries, scholarships, etc.

Name of Organization	Date Received	Amount Received

Complete and Upload Schedule B (Budget Information)*
Please use the Budget Template Found on the SpencerCreo Impact Award Website
Applicant Declaration*
I understand that I am applying for funding based on financial need. That by checking the box below, I certify that the information I have provided on this application is complete and accurate. I intend to be a student for the academic period stated in this application.

Personal information collected on this form is collected under the authority of the Personal Information Protection Act (PIPA) and is subject to all the provisions of the Act. The personal information collected will be kept confidential and only be used by Family Services of Greater Vancouver to administer payments of the SpencerCreo Impact Award. If you have any specific questions concerning the collection and use of personal information, please contact the Privacy Officer of Family Services of Greater Vancouver.

I also understand and accept that Family Services of Greater Vancouver will contact me up to six months after program completion to obtain feedback about the impact of this award.

I certify that the information I have provided is complete and accurate

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Sponsor Organization Information
To be completed by SPONSOR ORGANIZATION. Please upload Sponsor Information Form, Risk Assessment & Mitigation Plan once your support worker has completed them. All forms can be found on the SpencerCreo Impact Award website.
https://fsgv.ca/spencercreo-impact-award/
Sponsor Organization Information*
Risk Assessment and Mitigation Plan*
**OPTIONAL** Sponsor Organization Expenses- Schedule B (Budget Information)
Complete this section only if sponsor organization requires funding to provide support hours to the sponsored student). Downloadable template can be found on the SpencerCreo Website

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Applicant Personal Information