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Health Sciences Rural Practicum Bursary Application

The personal information that you provide on this form is being collected under the authority of the Freedom of Information and Protection of Privacy Act of Alberta, section 33(c). It will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta and will be retained in accordance with the Information Management policy and guidelines. This information will be used by the Student Connect Centre for the purpose of selecting the recipient(s) of awards and scholarships. If you have questions regarding this form, please contact the Student Connect Centre, room 1102, Red Deer Polytechnic, Box 5005, 100 College Blvd, Red Deer, Alberta, T4N 5H5, 403.342.3254. 

Personal Information
Please input your 10-digit phone number with area code.
Practicum Information
Please provide first and last name.
This electronic signature is treated by RDC like a handwritten signature on a paper form. 

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Red Deer Polytechnic Inquiries

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Main Phone: 403.342.3400
Toll-free: 1.888.732.4630 (in Canada only)
Email: inquire [at] rdpolytech [dot] ca

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