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Health & Recreation Grant Application
Health & Recreation Grant Application
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2021-09-09T21:20:17+00:00
2022 Health & Rec Grant Application Form
"
*
" indicates required fields
Application Deadlines:
First Deadline: April 22, 2022
Cheque Issued: May 20, 2022
Second Deadline: October 21, 2022
Cheque Issued: November 25, 2022
Each registered Tsawout Member, 18 years of age and older must complete an application in order to receive the grant.
Name
*
Last Name
First Name
Middle Initial
Status Card Number
*
Date of Birth
*
Month
Day
Year
Telephone Number
*
Address
*
Street Address
PO Box
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Proof of Residency
*
Proof of residency can include a utility bill, driver's license, Care Card.
Max. file size: 40 MB.
Dependents
Are you claiming dependents?
*
Yes
No
Are the dependents your own children?
*
Yes
No
Proof of Guardianship
If claiming for dependents that are NOT your own children, upload Proof of Guardianship documentation.
Max. file size: 40 MB.
Dependent(s) - Full Name and Status Card #
Full Name
Status Card #
Birth date (mm/dd/yyy)
Add
Remove
Do you have Custody Orders?
*
No
Yes
Upload Custody Orders
*
Where applicable, upload proof of custody (where biological parents have separated and children are residing with a custodial parent).
Max. file size: 40 MB.
Intended Use of Grant
Please select one or more intended uses of Grant
Health Uses
*
Conference Registration
Transportation Cost
Cultural
Travel Costs
Other health use
Recreation Uses
*
Sports Registration Fee
Equipment Purchases
Lessons
Fitness Membership
Other recreation use
Applicant Signature
*
Date Signed
*
Month
Day
Year
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