Last Name:
CAMPUS TOUR BURSARY APPLICATION FORM
Campus Tour Form Submission Deadline Date: July 15, 2017
STUDENT INFORMATION
First Name:
Street Address:
City:
Province, Postal Code:
Student ID Number (if you have already applied to Nipissing)
Date of Birth:
Phone Number:
Email Address:
Citizenship:
QUESTIONAIRE
Please indicate how many kilometers you have travelled:
☐ 150 kms or more (but less than 349 kms)
☐ 350 kms or more
Please check all of the following that apply to your campus tour bursary application:
☐ I am a citizen, a permanent resident of Canada or someone who is currently residing in Canada on
a student visa
☐ I intend to begin my studies at Nipissing University in September 2017
☐ I booked and participated in a tour through Nipissing University’s Office of Student Recruitment
☐ My campus tour was on: (mo-day-yr, time): _______________________________________________
☐ My travel dates were from: _______________________________ to _______________________________
☐ Yes
☐ No By checking yes, you verify that the information in this application is accurate and
Student Signature:
that you have read, and agree to the eligibility criteria outlined on the first page.
Date Application Received:
Date:
OFFICE USE ONLY (DO NOT COMPLETE)
Confirmation of Tour Date:
Recruitment Coordinator Signature:
Application Complete: ☐ Yes ☐
Eligible Bursary Amount (once attending):
No
Date Posted to fee account: _________________________ Student Awards & Financial Aid Signature:
Award Code:
Please mail or email your completed Campus Tour Bursary Application Form to:
Office of Student Recruitment
Nipissing University
100 College Drive, Box 5002
North Bay, ON P1B 8L7
[email protected]