Dr. Gautham Kolluri Endowed Bursary Application Form

Dr. Gautham Kolluri Endowed Bursary

Student Number:(Required)

Student Name:(Required)

First Last

Student Email Address:(Required)

Enter Email Confirm Email

When is the start of your program?(Required)

Program Name(Required)

Please enter your personal statement outlining the nature of your financial need. (Max 1500 characters)(Required)

Submit one (1) piece of supporting documentation demonstrating your financial need for the bursary(Required)

Please do not submit any documents which contain sensitive personal information, such as Social Insurance Numbers (SIN), financial account/credit card numbers, Passport/Visa numbers, and Health Insurance numbers/information, etc. Only provide documents that are directly relevant to your application.

For Example, Do Not Upload:

Bank or Credit Card Statements
Government Tax Documents
Documents containing a Social Insurance Number
Government IDs (Passports, Visas, Health Cards)
Private Medical Information

with the exception of doctor’s notes to the school, death certificates, etc. which are acceptable.

Check from the list below which document you are submitting.

Financial statement

Proof of financial loan or OSAP

Proof of loss of employment

Physician’s statement confirming hardship due to medical reasons

Other documentation confirming extenuating financial circumstances

Attachments

Drop files here or

Max. file size: 25 MB.

Declaration:(Required)

I have provided a full and accurate account of my situation. I recognize that it is my responsibility to include relevant documentation. By uploading any documents on this form, I acknowledge and accept that I do so at my own risk. I understand that these documents should not contain specific sensitive personal information in accordance with the guidelines provided above.

I understand the decisions of the committee are final and cannot be appealed.