THE KULLY SEKHON MEMORIAL FUND

Awards Application Form

Personal Information

Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

Province

Postal Code

Phone (Home/Cell)

Phone (Work)

Current Position

Department

Facility/Site Location

In this position since

Month and Year

Checkbox

Full Time Part Time Casual

FUNDING REQUEST

Are you applying for funding for this program from elsewhere?

Yes No

If yes, what is the maximum amount you would expect to receive from other sources CA$

Program/Course Information

Program/Course Title*

Date(s) of Program/Course

City and Venue

Organization Providing Program/Course

Certificate of Registration is Required

Registration/Tuition Fees CA$

A minimum grant of $200 will be given. Grants shall not exceed 50% of registration/tuition fee.

Please Attach Certificate of Registration Here

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Please Attach Program/Tuition Fee Receipt Here

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A copy of the receipt is required. If applying before acceptance in the program this may be deferred.

BENEFIT OF PROGRAM

Please describe why you choose to attend this program/course?

How will this program/course benefit care to the elderly?

How will program/course benefit you in your current position?

Support for the application is required from either your manager or supervisor.

A letter is required from your manager or supervisor. Please make sure that your manager or supervisor completes the online form "Manager or Supervisor Support" which can found at the bottom of our awards page: https://gvef.org/staff-education-awards-program/

The following information will be required:

- Please describe how you anticipate your employee's participation in this program benefits the care of the elderly clients.

- Does the program/course in which your employee is enrolled align with the priorities of your program.

- How will knowledge gained enable you to meet your programs priorities.

Please Check One of the Following Two Boxes Below and Sign and Date Your Application Form

I confirm that I have attended the institution described in this application

Yes

I have provided copies of all requested documents. If this application is successful, I agree to the publication of my name as an award recipient at the discretion of the Greater Victoria Eldercare Foundation.

I confirm that I intend to attend the institution described in this application

Yes

I agree to the publication of my name as an award recipient at the discretion of the Greater Victoria Eldercare Foundation. I am aware that if I am granted an award that I must provide copies of all requested documents within 6 months of the completion of the degree program and/or course work.

Signature

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Date

Month\Day\Year