ankgoel@watmsg.waterloo.edu (anil k goel) (05/03/91)
NAME:_______________________________________________________ SEX*: M F
CAMPUS MAILING ADDRESS: DEPARTMENT ______________________BUILDING_________
UW EXTENSION:___________HOME PHONE #:__________________STUDENT #__________
PROGRAM: M.A. Ph.D. TERM IN PROGRESS:_____________
REGISTRATION STATUS: FULL-TIME PART-TIME
FINANCIAL SUPPORT FOR SPRING TERM (specify term total in Canadian dollars):
T.A. $__________________
R.A. $__________________
SCHOLARSHIPS: $__________________
OSAP: $__________________
OTHER: $__________________
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TOTAL SUPPORT
FOR SPRING TERM $__________________
ARE YOU A SINGLE PARENT? YES NO
NUMBER OF CHILDREN: _______________
CHILD'S NAME AGE CENTRE & FULL/PART COST/MONTH WAITING LIST?
________________________PHONE #_____TIME CARE IF YES,POSITION
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HAVE YOU APPLIED OR DO YOU PLAN TO APPLY FOR DAY CARE BURSARIES FROM YOUR
FACULTY? YES NO
IF YES, WHICH FACULTY?
HAVE YOU APPLIED FOR A REGIONAL DAY CARE SUBSIDY? YES NO
IF YES, HOW MUCH ARE YOU RECEIVING?
DON'T FORGET TO INCLUDE A PHOTOCOPY OF A RECEIPT OR LETTER FROM THE
DAY CARE CENTRE. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED!
*NOTE: You must be female to qualify for a bursary.
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PLEASE RETURN APPLICATION TO:
Anil Goel
Day Care Committee
Graduate Student Association
Grad House
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