Apprentice Scholarship Application Read Scholarship Information Package before submitting this form. Name(Required) First Last UA Card #(Required) Address City & Province Postal Code Email(Required) Phone(Required)Name of School(Required) Trade & Year of School(Required) School Start Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School End Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Payment Options(Required)–EFT (Direct Deposit)Mailout ChequePickup ChequeChoose payment option AboveHiddenOffice Use OnlyHiddenReclassificaiton. Apprentice Year or BTJ by :_____ on_____ Reclassified to what year or BTJ by _______ on ________HiddenWaiver sent. Y/N HiddenGood Standing Y/N HiddenTotal Hours HiddenStart Date Hours HiddenEnd Date Hours HiddenPromissory Note, Provincial Marks and Certification Verified by: HiddenAmount HiddenApproved by HiddenCheque # HiddenIssued On Promissary Demand NoteConsent(Required) I consent to the below policy.I hereby promise to pay to the order of The Edmonton Pipe Trades Educational Trust Fund (the “Trust) at 16120 – 118 Ave NW, Edmonton Alberta T5V 1C6, the sum of SEVEN HUNDRED AND TWENTY FIVE ($725.00) DOLLARS ON DEMAND, together with interest at the rate of TEN (10%) PER CENT PER ANNUM commencing on the date of this note. THIS PAYMENT represents payment of a Scholarship advanced by the Trust Fund of the Apprentice under its Apprenticeship Training Program for the period of ONE (1) YEAR inclusive, in accordance with the terms and provisions of an Apprenticeship Scholarship Agreement between the undersigned and the Trust Fund as of the date below. THE SCHOLARSHIP FUNDS herein are advanced on the understanding that the recipient will only work with signatory or approved Contractors of UA Local 488 for at least of a period of 1 (ONE) year from the advance of the funds. Upon the expiry of 1 (ONE) year the Promissory Note herein will be deemed VOID. Electronic Funds Transfer (EFT) Authorization For Credit TransferFill the following section out if requesting Direct Deposit payment (EFT)Void Cheque or Direct Deposit InformationMax. file size: 50 MB.Request TypeInitial RequestChange RequestName of Bank or Financial Institute Branch Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Branch NumberInstitution NumberAccount NumberConsent I agree to the below policyI authorize the Edmonton Pipe Trades Trust Fund and ATB to use the services of any member or affiliate of the Canadian Payments Association (CPA) in carrying out this authorization. I agree to be bound by the standards, rules, and practices of CPA as they may exist from time to time. I agree to give written notice of cancellation of this authorization to Edmonton Pipe Trades Educational Trust Fund and be bound by this authorization until the Edmonton Pipe Trades Educational Trust Fund has had reasonable time to act on the notice. Edmonton Pipe Trades Educational Trust Fund and/or ATB may terminate this authorization by providing me with ten (10) days’ notice. I undertake to inform Edmonton Pipe Trades Educational Trust Fund within five (5) days of any changes to branch, account, and institution number while this authorization is in effect.File UploadsSchool Reciept (Tuition Fee)(Required)Max. file size: 50 MB.Alberta Learning Letter with Marks(Required)Max. file size: 50 MB.AIT ID Card, Journeyperson Letter or Journeyperson Certificate(Required)Max. file size: 50 MB.
