Bursary Entry Form

* Required Field

Student Information

*First Name

*Last Name:

Preferred Pronouns

*Address:

What post-secondary school will you be attending?

*City/Town

*Province:

* Postal Code:

*Telephone Number:
( ) -

Insured Member Information

*Name of the person who is an OTIP member (you, your parent, step-parent, grandparent, aunt, uncle or legal guardian)

Affiliate/Union of OTIP member

Type of Insurance

Plan or Policy Number

*How did you hear about OTIP’s Bursary Program?

If other, please specify:

Student Status

I will be attending college or university on a full-time or part-time basis for the upcoming academic year.

Declaration

I have read and I understand the regulations under OTIP's bursary program, agree to be bound by these regulations, and declare that the information in support of my application for a bursary is true and correct.

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