Sipeknekatik Sport and Recreation Education Scholarship Program

(SSRESP)
AVAILABLITY:
SSRESP is available to Elite Youth (21 years and under) an individual who continuously excels within a
sport or recreation activity.
APPLICATION FUNDING OPPORTUNITY AMOUNTS AND DEADLINES DATES:
(Elite Athletes will have the opportunity to apply twice per year at the deadlines listed below).
Funding Amounts Available: $1,000.00 - per elite youth, or $2,500.00 - per elite youth, depending
upon registration cost
Spring/Summer Sport and Recreation Deadline, March 1st April 30th (if this date should fall on a
weekend it will be the last Friday in April)
Fall/Winter Sport and Recreation Deadline, August 1st September 30th (if this date should fall on a
weekend it will be the last Friday in September)
WHO IS ELIGIBILE:
Children and youth registered with the Sipeknekatik Band 21 years of age or under.
APPROVAL PROCESS:
The approval of each youth will be determined by the SSRESP seven (7) committee members:
1. Joan Paul, Recreation Manager
2. Logan Gehue, Recreation Support Worker
3. Sharon Paul, Recreation Support Worker
4. Nathan Sack, Direction of Operations
5. Matthew Horton, Director of Finances
6. One (1) Sipeknekatik Band Councilor
7. Doris Maloney, (Former Education Director) One (1) Elder
APPLICATION GUIDELINES:
Each applicant MUST ensure each section of the application is completed. A failure to do so will
result in an incomplete application. **NO incomplete applications will be accepted.
Applicant MUST complete and return application before the last day of the deadline dates listed
(see above for deadline dates). A failure to do so will result in an incomplete application. **NO
incomplete applications will be accepted
APPLICATION INFORMATION CHECKLIST:
Application
Essay
Proof of Grades
Budget Sheets

Proof of Income (T4)

Three (3) Reference Letters
Proof of Acceptance
Proof of Membership

DISCIPLINARY ACTION:
If an applicant should quit or is expelled for any reason from the sport or recreation activity
they are seeking funding assistance for he/she will then be placed on a probation period of
one (1) year from the date of their approval. The applicant will NOT be eligible to apply for
SSRESP up to a maximum of one (1) consecutive year.

APPLICANT INITIAL________

Sipeknekatik Sport and Recreation Education Scholarship Program

(SSRESP)
SPORT AND RECREATION GUIDELINES
1. APPLICATION; How to Apply:
Applicant MUST complete the following criteria below to have a complete application and
submit to Recreation Manger by the last day of the listed deadline date that you are seeking
funding assistance for.
2. SPORT OR RECREATION DESCRIPTION; Essay:
Describe specifically what you are applying for, including your goals if approved for
funding maximum one page.

3.
4.
5.

6.

7.

8.

Must provide the title/name of your sport/recreation activity

Must identify the location of the sport/recreation activity
Must identify a start and completion date
Must provide a brief description of the sport/recreation activity
PROOF OF GRADES:
Must provide your most current copy of report card/transcripts.
BUDGET SHEETS:
Must submit a budget itemizing of all expenses and costs.
PROOF OF INCOME SOURCES AND OTHER FUNDING:
Must provide proof of income (T4) of both parent(s) and guardian(s).
Must identify all other sources of funding, including personal contributions, sponsorships, grants,
Sport Education Assistance Program, and fundraising.
REFERENCES:
Must provide three (3) letters of references: one (1) School Reference, one (1) Sport Reference,
one (1) Community Member, cannot be a family member. Included mailing address,
telephone number, and email address.
PROOF OF ACCEPTANCE:
Must provide letter(s) of acceptance within sport or recreation activity that you are seeking
funding assistance for.
PROOF OF MEMBERSHIP:
Must provide proof of Sipeknekatik membership status.

APPLICATION DEADLINES DATES:

Spring/Summer Sport Deadline: March 1st April 30th (if this date should fall on a weekend it will be
the last Friday in April).
Fall/Winter Sport Deadline: August 1st September 30th (if this date should fall on a weekend it will
be the last Friday in September).

Sipeknekatik Sport and Recreation

2

APPLICANT INITIAL________

Education Scholarship Program

Elite Application Form
Application Information
Full Name: ________________________________________ Date: ______________________
Last

First

M.I.

Address: ______________________________________________________________________
Street Address

City

Postal Code

Birthdate: ________________________________________

Age: ______________________

Band #: __________________________________________

Male: _____

Female ______

Education
School Name: ___________________________ Address: ______________________________
Current Grade: _________
College University: ______________________________________________________________
Did You Graduate: _______

Degree: ______________________________________________
References

Please List three (3) Sport References. Included three(3) letters from each reference.

Full Name: _______________________________ Email Address: ________________________

Sport Organization: ______________________________________________________________
Home Phone: ___________________________ Cell: ___________________________________
Mailing Address: ________________________________________________________________
Full Name: _______________________________ Email Address: ________________________
School Organization: _____________________________________________________________
Home Phone: ___________________________ Cell: ___________________________________
Mailing Address: ________________________________________________________________
Full Name: _______________________________ Email Address: ________________________
Community/City: _______________________________________________________________
Home Phone: ___________________________ Cell: ___________________________________
3

APPLICANT INITIAL________

Mailing Address: ________________________________________________________________

Level of Development
Currant Sport Name: ___________________________________ Division: __________________
Coach Name: __________________________________ Position: ________________________
Number of Years Played: _________________________________________________________
Please check all that apply to you:
1st Year: __________ 2nd Year: ___________ 3rd Year: __________ 4th Year +: ___________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this applicant leads to approval, I understand that any false or misleading information in my applicant
may result in my immediate disapproval.

Signature: _________________________________________ Date: ______________________

TO BE COMPLETD BY OFFICE
APPLICATION INFORMATION CHECKLIST:

Application Completed
Essay
Proof of Grades
Budget Sheets
Proof of Income (T4)
Three (3) Reference Letters
Proof of Acceptance
Proof of Membership
Sipknekatik Sport and Recreation Education Scholarship Program
(SSRESP)
NOTE: FAILURE TO ACCURATELY REPORT YOUR ACTUAL LIVING CIRCUMSTANCES WILL
RESULT IN:
A) Your current funding assistance will be revoked and immediate repayment will be require to
the Sipeknekatik Recreation Department; B) You will placed on a probation period of five (5)
years from the date of your initial approval date.

FINANCIAL NEED BUDGET SHEET

CURRENT MATEIAL STATUS:
Single

Married

Common Law

Divorced

Separated

Widowed/Widower

APPLICANT INITIAL________

DEPENDENTS:
None
1 2 3

More than 6

APPLICANT INITIAL________

List the ages of your dependents: ____________________________________________________________

CURRENT EMPLOYMENT:
Full time

part-time seasonal

unemployed

ANNUAL HOUESEHOLD INCOME

$_________________________________________________________________
Must submit a copy of the most recent T4 or Notice of Assessment for each parent and/or guardian
listed on this application*

MONTHLY INCOME SOURCES

Monthly income

from savings or work $ ________________

Monthly income from Spouse or Partner $ ________________
Other monthly income (please identify the source) $________________
Monthly Child Support, if applicable $________________
Monthly Child Tax Benefit $________________
Monthly Pension income (CPP, OAS, GAINS, Orphans allowance) $________________
Monthly Social Assistance (OW or ODSP) $________________
Any other sources of income not listed above $________________
TOTAL INCOME $________________

MONTHLY EXPENSES
Monthly mortgage/rent/shelter $_______________
Monthly food $___ ____________
Utility costs $ _______________
Monthly telephone, internet, cable $ _______________
Transportation $_______________
Monthly childcare $_______________
Monthly clothing and recreation $_______________
Insurance $_______________
Other monthly expenses (please list additional info on separate page) $_______________
TOTAL EXPENSES $_______________
Total monthly income (A) $_______________
Minus monthly expenses (B) $_______________

Surplus/shortfall (A-B) $______________

This application form must be submitted by person to the Sipeknekatik Recreation Department
located on the second level of the Sipeknekatik Multi Purpose Centre at the following address: 185
Sesame Street, Indian Brook, Nova Scotia.

Faxed or e-mail applications are NOT accepted.

Telephone: (902) 236-3020|Fax: (902) 236-3021|www.sipeknekatik.ca|Email:
joanpaul@sipeknekatik.ca

Sipknekatik Sport and Recreation Education Scholarship Program

(SSRESP)

BUDGET
SPORT/RECREATION ACTIVITY COSTS AMOUNT:

Please list ALL costs required to complete your sport/recreation activity (include number of
tournaments attending):
____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

____________________________________________

$ ___________________________________

TOTAL COSTS
$____________________________________

OTHER PROJECT FUNDING AMOUNT

Please list ALL other funding sources, confirmed or anticipated, for your sport/recreation activity:
____________________________________________
(Fundraising)

$ ____________________________________

____________________________________________
(Personal/Donation)

$ ____________________________________

____________________________________________
$_____________________________________
(Grants, Chief & Council, Grant Funds, other etc.)
____________________________________________
(Any other Funding possibilities)

$_____________________________________

Total Sports/Recreation Activity Funding $_____________________________________

Amount being requested from the Sipeknekatik Sport and Recreation Education
Scholarship Program:

$ ________________________________
____