Summary: APPLICATION FORM
UNIVERSITY OF REGINA FAMILY SCHOLARSHIP
This scholarship was established at the University of Regina to assist dependants of University of Regina employees who
are pursuing studies at the undergraduate or post-graduate level. Eligible recipients must be a recognized dependant of a
CUPE Local 1975-01 employee, an Administrative, Professional and Technical (APT) employee, an Academic Staff
Member, or an Out-of-Scope Employee.
Graduate Students should check the eligibility requirements at www.uregina.ca/gradstudies/scholarships.
Doctoral Masters U of R Student #
Semester you are applying for Fall Winter Year: ____________
Check one: Canadian Citizen Permanent Resident Temporary Resident (study permit)
Faculty: ________________________ Department/Academic Unit _________________________________
Mrs. Miss Last Name: ____________________________ First Name & Initial: ____________________
Mailing Address at time of application: (notification of award will be sent here) Phone (Home) _________________
________________________________________________________________ Phone (Work) _________________
City _________________________________ Prov_______________________ Postal Code _________ _________
Email Address: ___________________________________________________
Social Insurance Number: ____________________________
Note: A Social insurance number is required for income tax purposes and must be supplied I order for a scholarship to be paid out.