Bursary Application

Your Name (required)

Your Email (required)


Your Organization

Job Title

Telephone (required)

Mailing Address (required)

Employment Status

Funding requested for

If indicated other in the above, please specify

Name of Course or Activity

Date of Course or Activity

Location of Course or Activity

Web Link to Course or Activity if available

How will participation in this professional development activity benefit you and your organization?

Detail of Expenses

Amount Requested

Have you applied to another organization for financial assistance

If yes which organization

Additional Comments