Bursary Application Form

If you receive a bursary you may be required to submit a photocopy of your most recent tax return as proof of income.

Athlete’s Personal Information

Name(Required)

First Last

Are you 19 years of age or under?(Required)

Yes

Are you a Whistler resident?(Required)

Yes

Birth Date(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code

Disability(Required)

Parent/Guardian Information

If you are filling out the Bursary Application form for someone other than yourself, please include your information below:

Parent/Guardian Name

First Last

Parent/Guardian Contact Phone

Parent/Guardian Email

Financial Questions

If applicant is under 19 years old please enter the parent/guardians information below

Parent/Guardian

Bursaries are intended to support low-income families and individuals that could not otherwise afford these services. Please only apply if you are in financial need.

Does the applicant currently receive public assistance income (disability compensation, social security, etc.)

Yes

Number of people in household(Required)

Monthly household income: (Please include all household, job related and public assistance income)(Required)

Please include a breakdown of your top 6 montly expenses (utilities, rent/mortgage, meals, medical, therapy, etc.)

Expense 1

Expense Amount 1

Expense 2

Expense Amount 2

Expense 3

Expense Amount 3

Expense 4

Expense Amount 4

Expense 5

Expense Amount 5

Expense 6

Expense Amount 6

Total Expenses

Please send the T1 or notice of assessment for each earning adult in the household to info@whistleradaptive.com.

Do you rent or own your home?

Rent

Own

Do you own a second home or another property other than a business?

Yes

Specify the activities you wish to participate in through this bursary:(Required)

Specify the amount of financial assistance you are applying for through this bursary?(Required)

Please enter a number from 1 to 1000.

Max $1000

Have you participated previously in programs offered by the Whistler Adaptive Sports Program?(Required)

Yes

Please describe how you believe that participating in Whistler Adaptive Sports Programs will benefit you?(Required)

What other activities do you participate in?(Required)

Agreement

I have read and understood the application guidelines and requirements of bursary recipients. If I receive a bursary from the Whistler Adaptive Sports Program, I agree to those conditions. I understand that failure to comply with the requirements will result in being ineligible for a bursary for the following year. I also understand that I may be required to provide a copy of my tax return as proof of income.

Form completed by: (Name)

If this form was completed by someone other than the applicant, what is the relationship to the applicant?

Consent(Required)

I agree

I don't agree

The Whistler Adaptive Sports Program maintains a non-discriminatory application process. Whistler Adaptive does not award bursaries based on age, sex, race, colour, religion, national origin, disability, sexual orientation, marital status or veteran status.