The personal information that you provide on this form is being collected under the authority of the Freedom of Information and Protection of Privacy Act of Alberta, section 33(c). It will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta and will be retained in accordance with the Information Management policy and guidelines. This information will be used by the Student Connect Centre for the purpose of selecting the recipient(s) of bursary funds. If you have questions regarding this form, please contact the Student Connect Centre, room 1102, Red Deer College, Box 5005, 100 College Blvd, Red Deer, Alberta, T4N 5H5, 403.342.3254. First Name Last Name RDC Student ID Number? Date of Birth Please indicate whether you intend to study at a full-time or part-time course load in Fall 2022. Full-Time Part-Time Marital Status Single Married/Common Law Separated/Divorced/Widowed Number of Dependant Children Please indicate the number of dependents who are 18 years old or younger. Monthly Expenses Please input an estimate of the monthly expenses you will incur while you are a student. Rent/Mortgage Utilities Child Care Food, Clothing and Personal Care Medical/Dental Coverage Transit (insurance, gas, bus pass, etc.) Spousal/Child Support Payments Debt Payments Please describe your debt payments: Other Expenses (not listed above) Please describe your other expenses: Monthly Income Please input the monthly income you expect to earn/receive while you are a student. Income From Employment If you will not be working during your studies, please indicate why: Spouse/Partner's Income Employment Insurance (EI) Benefits Spousal/Child Support Received Income from Other Sources Please describe your other sources of income: By submitting this form: I confirm all information given is true and complete in all respects. Signature This electronic signature is treated by RDC like a handwritten signature on a paper form. Leave this field blank