PSE Application | Outcomes Student Information System

Samson Post Secondary & Nipisihkopahk Iyinisiwin Trust Fund

This form is intended for students applying for Post Secondary Student Support Program (PSSSP) and Nipisihkopahk Iyinisiwin Trust funding

Once you apply and are approved for one program, you will be able to log into your student page to apply for the second program (when applicable)

If you already have records in the Outcomes Student Information System, please log in via the student page and complete the form there.

If you have no existing records or do not know, you can add all needed information to this form and submit when ready.

(for returning students)

(for staff)

* denotes a required field.

* Select Site

Identifying Information

* Type of Student

* Status Card #

* Status Card # - also known as INAC or Treaty Number - is a 10 digit number made up of your band number, family number and position number.

* Birth Date

* Gender

* First Name

* Last Name

Common First Name

Previous Last Name

* Email

* Your email address will be used to log in and manage your application.

SIN

Student ID

Program Dates

* Academic Year * Semester(s) check all
Spring 2024 Summer 2024 Fall 2024 Winter 2025

*Program Start Date

Estimated Graduation Date

Note, on one application you can only apply for semesters from one fiscal year. To include semesters from multiple fiscal years, additional applications must be filled out.

Program Information

* Institution / School Name

* Level of Education Sought

* Attendance

* Method of Delivery

* Major Area of Study

* Area of Study - Subcategory

* Years of Study Required

* Year of Study Applying For

*Program Name

Personal Details

* Street Address

* City

* Province

* Postal Code

* Phone Number

Emergency Contact Name

Emergency Contact Phone

* Are you a Canadian Resident?

* Do you live On or Off Reserve?

* Have you lived in Canada at least 1 Year?

* Marital Status

* Number of Dependants

* Are you a High School Graduate?

Do you require coverage for health/dental fees?

Do you have dependants enrolled at a subsidized daycare?

Are you a student with any special learning needs?

Learning needs details: (Ex: IEP, Psycho-Educational, Assessments, etc.)

Notes

Education Plan

* 1. Career Goal

Characters left: 1000

* 2. Please explain why you have chosen this field

Characters left: 1000

* 3. Describe your plan for completing the program (Example: number of courses per semester and total length of the program)

Characters left: 1000

Note, you must be enrolled full time each semester to receive living allowance. Full time status is decided by each individual school.

* 4. Do you plan on continuing your education beyond this program?

4b. If Yes was answered above, please describe in detail your long-term education plan (include other programs you may wish to attend beyond this program)

Post Secondary Costs

Please enter your estimated yearly tuition. Book and living allowance amounts are fixed. Note that Living Allowance amounts are only added if you selected full-time attendance above.

Estimated tuition per year: $ × # years = $0.00

Books per semester: $ × # semesters × # years = $0.00

Living Allowance per month (single): $ × # months × # years = $0.00

Total estimated costs: $0.00

Final Application Details

*Do you plan on staying at residence on campus?

* Have you been previously funded by PSSSP?

Please add any relevant IEP details you would like added to your application.

Please select your Priority Level based on the following guidelines.

(1) Continuing students and OSSD students;

(2) Mature students;

Select applicable Priority Level

Outcomes - A Product of Dadavan Systems Inc

Samson Post Secondary & Nipisihkopahk Iyinisiwin Trust Fund

Identifying Information

Program Dates

Program Information

Personal Details

Education Plan

Post Secondary Costs

* Post Secondary Expenses

Final Application Details