LANGUAGES IN TEACHER EDUCATION 16/17 SCHOLARSHIP – Nomination Form Award Value – $ 2,500

This scholarship program is designed to reward post-secondary students enrolled in a recognized Alberta teacher preparation program taking courses that will allow them to teach languages other than English, including FNMI (First Nations, Métis, Inuit) languages in Alberta schools. This scholarship was created by an endowment from the Government of Alberta to the Alberta Heritage Scholarship Fund to build provincial capacity in the area of language education.

Eligibility Criteria

A candidate must: • be a Canadian Citizen, Permanent Resident or Protected Person - visa students are not eligible, • be an Alberta resident, and to be considered an Alberta resident one of the following conditions must apply: -- one parent must currently be residing in Alberta, or -- Alberta is the last place the nominee has lived for 12 consecutive months before being a full-time student, or -- is married to an Alberta resident before the start of the qualifying year of study. • be enrolled full-time in the final two years of a recognized Alberta teacher preparation program offered by an Alberta Faculty of Education. Note: A student may only receive this scholarship once.

Selection Process

Recipients are nominated by the Faculty of Education at each eligible post-secondary institutions. Institutions will select students who meet the eligibility criteria and who are completing an education program that will allow them to be a language teacher in Alberta schools after they graduate.

Additional Information

Eligible Institutions • • • Campus Saint-Jean • Concordia University of Edmonton • • St. Mary’s University • The King’s University • • University of •

Alberta Student Number (ASN) Deadline and How to Apply

Your Alberta Student Number is on your Alberta Transcript • Application Deadline: Students must submit completed for High School Achievement. applications directly to Student Awards Offices at their schools by the posted application deadline. If you do not know your ASN, or do not have an ASN: • Post-Secondary Institution Nomination Deadline for • Visit iae.alberta.ca/ASN for instructions. submission to Student Aid Alberta: February 15, 2017 • Call toll-free in Alberta at 310-0000 to have a Request for ASN form mailed to you. Due to privacy issues, ASN’s will Contact: Student Aid Alberta Service Centre at 1-855-606-2096 not be given over the phone. Visit: studentaid.alberta.ca/scholarships

LANGUAGES IN TEACHER EDUCATION SCHOLARSHIP - Nomination Form Last revised July 2016 LANGUAGES IN TEACHER EDUCATION 16/17 SCHOLARSHIP – Nomination Form To be Submitted by the Post-Secondary Institution

Advanced Education is collecting the personal information on this form under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP Act), as being directly related to and necessary to determine your eligibility for a scholarship under the Alberta Heritage Scholarship Act and to administer scholarships including research, statistical analysis and program evaluation. The use and disclosure of your personal information is managed in accordance with the FOIP Act. If you have any questions about the collection, use or disclosure of this information, call the Student Aid Alberta Service Centre toll free at 1-855-606-2096 from anywhere in . You can also mail your questions to Student Aid Alberta, PO Box 28000 Station Main, Edmonton AB T5J 4R4. Personal Information

Last Name (current legal name) Social Insurance Number

Middle First Name (current legal name) Initial Gender  Male Female Apartment or Box Number   Another/Prefer not to disclose

Street Address Day Month Year Birthdate

City/Town Previous Last Name (if applicable)

Prov/State Country Postal/Zip Code Alberta Student Number (mandatory)

Mobile Number (format: 999-999-9999)

Email Address Telephone Number (format: 999-999-9999)

Citizenship and Residency Information

Citizenship Status: (check one) Alberta Residency:  Canadian  Permanent Resident  Protected Person Did you or one of your parent(s)/ legal guardian live in Alberta all your life?  VISA (International Student)  Yes  No If no, is Alberta the last province you have Indigenous Status: lived in for 12 consecutive months prior to  Status Indian/First Nations post-secondary studies? Non-Status Indian/First Nations  Yes  No If no, are you married to  an Alberta resident before  Métis the start of the qualifying  Inuit year of study?  Not applicable  Yes  No

Providing personal information on Indigenous students will help measure the effectiveness of student financial assistance programs in relation to Indigenous students and to research programs and services to improve student success rates. If you wish to declare your Indigenous heritage, please check the box that applies to you. NOTE: This is mandatory for awards which require Indigenous status as part of the eligibility, voluntary otherwise.

For Office Use Only 50 8 8 8 GRANT TOTAL AWD INSTIT PGM DA MO YR DA MO YR Disbursement E MO YR AUTHORIZATION AWARD KEY APP KEY

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Post-Secondary Institution Enrolment Information

Post-Secondary Institution Name Study Start Date Month Year

Address Program of Study

City/Town Prov/State Program Length

Years Months Country Postal/Zip Code   Year of Program Student ID

Additional Information

Indicate your grade level of focus:  Elementary Education  Secondary Education Upon completion of your program, do you plan to teach in Alberta?  Yes  No Language Background What is your first language/mother tongue?

For FNMI nominees, what learning/background will allow you to teach your language and culture (e.g. at university, college, CILLDI, ATEP).

Indicate the language(s) you will be able to teach upon completion of your Alberta teacher preparation program

Indicate where you plan to teach the above language(s) and why you want to teach languages

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Declaration of Nominating Party

To be Completed by the Post-Secondary Institution: I hereby declare that this student has been selected for this scholarship and meets the required eligibility and obligations.

Name (please print) Position

Signature Date

Declaration of Applicant

I have read and understand the instructions, and declare that: • personal information pertaining to my post-secondary • all information provided is true and complete and I understand academic progress and enrolment status may be released it is subject to audit. and exchanged by and between Student Aid Alberta and the educational institution for the purpose of determining • I will meet any eligibility requirements and obligations of my eligibility for a scholarship. the scholarship as stated in the scholarship requirements. • my personal information may be released and exchanged by • I will immediately notify Student Aid Alberta in writing and between Student Aid Alberta and any federal and provincial if I withdraw from studies. government departments, boards, or institutions to verify the I understand that: information I have provided to Student Aid Alberta, and for the use in research and statistical analysis in program evaluation. • personal information pertaining to my high school and post- secondary academic records may be released and exchanged I understand and agree that: by and between Student Aid Alberta, Alberta Education and • if I receive a scholarship my name, award and city/town the educational institutions for the purpose of determining may be released publicly to promote the program, however, my eligibility for a scholarship. this is not a criterion for eligibility, and if I do not want to be identified, I will contact Student Aid Alberta.

Signature of Applicant (in ink) Today’s Date ✗✗SIGN HERE Day Month Year

Please Review Your Application to Make Sure you Have Completed All the Required Fields. Missing Information Will Delay Processing.

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