Pathway Technology Funding Request

Name Name First Last
Student Number
Email
Where is your home campus?

Where is your home campus? Castlegar Grand Forks Kaslo Nakusp Silver King Trail Out of Region - Please tell us where you are.
Which Pathway are you registered in?

Which Pathway are you registered in? Health (HCA, PN, BScN) Human Services (e.g., EACSW, SSW) STEM (Science, Technology, Engineering, Medicine)
Which semester are enrolled in?
Technology Request
Are you AUG funded?

Are you AUG funded? Yes No Unsure
If yes, have you applied for the AUG technology fund? (If eligible, you must first apply for this funding. See the application here: https://forms.selkirk.ca/view.php?id=221810)

If yes, have you applied for the AUG technology fund? (If eligible, you must first apply for this funding. See the application here: https://forms.selkirk.ca/view.php?id=221810) Yes, I have applied No, I haven't yet applied (but I will right now!)
Describe the technology support that you are requesting. Up to $500 is available per academic year for the following categories:

1. Hardware: could include a computer, monitor, webcam, mouse, keyboard, etc.
2. Software: could include assistive technology software. Please note that as a Selkirk student, you have access to free Microsoft Office 365, which includes Word, Excel, PowerPoint, etc., that can be used online or downloaded to your computer. Check https://go.selkirk.ca/ for details.
3. Internet access: could include installation, connection, upgrade, monthly bill, etc.
Upload a screenshot of the item you wish to purchase or your internet bill, if applicable. Ensure the total cost is included in the image.

Please note, you must send a receipt of your purchase within 2 weeks to upgrading@selkirk.ca.

Attach Files
Taxable Income - T4A Slips
The Canada Revenue Agency requires the College to issue a T4A slip for bursary and scholarship funds that total more than $499 in a calendar year.

Pathway funds received for technology are included in this taxable income. T4As will be mailed to the address on your student record in February each year.
Mailing address

This is the description of your section break.
Your Pathway funding cheque will be mailed to the address on your student record.

If you would like the cheque to be directed elsewhere, please fill in your preferred mailing address below. Your Pathway funding cheque will be mailed to the address on your student record.

If you would like the cheque to be directed elsewhere, please fill in your preferred mailing address below.
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Declaration

I declare that the information contained herein and all statements made in connection with this application are true, correct and complete.

I understand that I may be asked to submit supporting documents to verify the information provided in this application.

I understand that any misrepresentation or incomplete disclosure on or relating to this application may result in the cancellation or repayment of the funding.

I understand and agree that if I do not submit a receipt to your pathway coordinator for the technology purchased, a charge for the bursary amount received will be charged to my student account.

This is the description of your section break.
Type or draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
If you have questions, please contact your pathway coordinator.

Pathway Technology Funding Request

Pathway Technology Funding Request

Technology Request

Mailing address

If you have questions, please contact your pathway coordinator.