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L Information Name Student # Street Address City Province/State Country Postal/ZIP Code Social Insurance/Security # Birth Date Email Phone # II. Bursary Application I hereby apply for the following bursary: Dependent of faculty/staff (full-time or part-time) Name of faculty/staff parent S.I.N. Spouse of full-time student Name of student S.I.N. Alumni Student Bursary Course name Term Credit/Audit/Online PTS/UCOLL Senior Citizen Bursary Course name.

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