This form is unique to you and can only be used once. Once the form has been submitted, this page will no longer be accessible so make sure your data is complete and accurate. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 6Personal InformationName *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeEmail *Phone *NextFunding DisclosureIMPORTANT NOTE: ONLY complete this section if you received any funding outside of HEABC to pay for expenses related to your HCA registration.Applicants are required to disclose any and all prospective sources of funding that will directly support education and registration pathways to becoming an HCA. Applicants are required to disclose any funding received from Career Paths for Skilled Immigrants - Douglas College program or any Return of Service (ROS) commitments such as the IEN Bursary. Sources of funding include all federal, provincial, territorial or municipal governments (total government assistance) and other sources that are expected to be received.Other Funding Source(s) Received? *Select from this dropdownYesNoFunding SourceExpense CoveredFunding Amount ($)PreviousNextLearning PlanThis Learning Plan outlines the conditions, including remedial education requirements and completion timeframes, to ensure eligibility to receive the bursary funds. The following Learning Plan was discussed during my consultation call with the HCA team.Remedial Education Requirement #1 Course/Program *Select the course from this dropdownHealth Care Assistant Practice in British ColumbiaRecognizing and Responding to Adult AbuseViolence Prevention E-ModulesBody Mechanics and Client Mobility Online ModuleHCA Infection Prevention Online ModuleMedication Basics Online ModulePlanning, Time Management and Organization Online ModuleHealing 1: Caring for Individuals Experiencing Common Health ChallengesHealing 2: Caring for Individuals Experiencing Cognitive or Mental Health ChallengesHealing 3: Personal Care and Assistance Course (with both theory and lab skills component)Health 1: Interpersonal CommunicationsHealth Care Assistant-Introduction to Practice CourseFull HCA ProgramHCA Access ProgramHCA Upgrade ProgramDementia Care Knowledge and SupportMental Health First AidNext Steps *Required Completion Date *Add another course/programRemedial Education Requirement #2Course/ProgramSelect the course from this dropdownHealth Care Assistant Practice in British ColumbiaRecognizing and Responding to Adult AbuseViolence Prevention E-ModulesBody Mechanics and Client Mobility Online ModuleHCA Infection Prevention Online ModuleMedication Basics Online ModulePlanning, Time Management and Organization Online ModuleHealing 1: Caring for Individuals Experiencing Common Health ChallengesHealing 2: Caring for Individuals Experiencing Cognitive or Mental Health ChallengesHealing 3: Personal Care and Assistance Course (with both theory and lab skills component)Health 1: Interpersonal CommunicationsHealth Care Assistant-Introduction to Practice CourseFull HCA ProgramHCA Access ProgramHCA Upgrade ProgramDementia Care Knowledge and SupportMental Health First AidNext StepsRequired Completion DateAdd another course/programRemedial Education Requirement #3Course/ProgramSelect the course from this dropdownHealth Care Assistant Practice in British ColumbiaRecognizing and Responding to Adult AbuseViolence Prevention E-ModulesBody Mechanics and Client Mobility Online ModuleHCA Infection Prevention Online ModuleMedication Basics Online ModulePlanning, Time Management and Organization Online ModuleHealing 1: Caring for Individuals Experiencing Common Health ChallengesHealing 2: Caring for Individuals Experiencing Cognitive or Mental Health ChallengesHealing 3: Personal Care and Assistance Course (with both theory and lab skills component)Health 1: Interpersonal CommunicationsHealth Care Assistant-Introduction to Practice CourseFull HCA ProgramHCA Access ProgramHCA Upgrade ProgramDementia Care Knowledge and SupportMental Health First AidNext StepsRequired Completion DateAdd another course/programRemedial Education Requirement #4Course/ProgramSelect the course from this dropdownHealth Care Assistant Practice in British ColumbiaRecognizing and Responding to Adult AbuseViolence Prevention E-ModulesBody Mechanics and Client Mobility Online ModuleHCA Infection Prevention Online ModuleMedication Basics Online ModulePlanning, Time Management and Organization Online ModuleHealing 1: Caring for Individuals Experiencing Common Health ChallengesHealing 2: Caring for Individuals Experiencing Cognitive or Mental Health ChallengesHealing 3: Personal Care and Assistance Course (with both theory and lab skills component)Health 1: Interpersonal CommunicationsHealth Care Assistant-Introduction to Practice CourseFull HCA ProgramHCA Access ProgramHCA Upgrade ProgramDementia Care Knowledge and SupportMental Health First AidNext StepsRequired Completion Date As per the Required Completion Date(s) outlined above, it can be expected that I will be registered with the Registry approximately two months after my course completion dates.PreviousNextDocuments Required1. Original Remedial Education Referral Letter from the Registry. * Click or drag a file to this area to upload. 2. Rural travel allowance supporting documents (if eligible) as proof of primary residence. Click or drag a file to this area to upload. PreviousNextBursary DistributionThe bursary will be provided (via direct deposit) when I complete the requirements outlined in the Learning Plan section and within 6-8 weeks of the Registry receiving my registration with the Registry. Date of Birth *A valid Canadian Social Insurance Number (SIN) *If your SIN # starts with a ‘9’, include your work/study permit expiry date:To facilitate electronic transfer of funds to your bank account and to issue a T4A, as the bursary is taxable income, HEABC requires a valid Social Insurance Number (SIN) as of the date funds are issued as well as the below information:Upload Void Cheque or Direct Deposit Form * Click or drag a file to this area to upload. PreviousNextAcknowledgement & ConsentCheck the boxes below in order to finalize and submit your applicationAs indicated by my agreement below, I confirm that the contents of this application are true and complete to the best of my knowledge and belief. I understand and agree that if I make a false or misleading statement or representation with respect to my application, I will not be eligible for this bursary. *As indicated by my agreement below, I confirm that the contents of this application are true and complete to the best of my knowledge and belief. I understand and agree that if I make a false or misleading statement or representation with respect to my application, I will not be eligible for this bursary.I understand that I must complete all of the remedial education requirements set above within the established timeframes to be eligible to receive the bursary funds. If there are any changes to my course date(s) established in this bursary agreement, I must notify the HCA Team in writing by sending an email to info@choose2care.ca explaining the reasons I was unable to complete the course within the established timeframes. Should I not complete these requirements by the above deadline, I understand that absent extenuating circumstances beyond my control, I will become disqualified from receiving any bursary funds. *I understand that I must complete all of the remedial education requirements set above within the established timeframes to be eligible to receive the bursary funds. If there are any changes to my course date(s) established in this bursary agreement, I must notify the HCA Team in writing by sending an email to info@choose2care.ca explaining the reasons I was unable to complete the course within the established timeframes. Should I not complete these requirements by the above deadline, I understand that absent extenuating circumstances beyond my control, I will become disqualified from receiving any bursary funds.I understand that all personal information related to my application for the Remedial Education Bursary is collected in accordance with applicable privacy legislation, for the purposes of administering my participation in the program, facilitating the evaluation process, funding verification, entitlement, disbursement of financial stipends, grants, reimbursement or waiver programs, statistical analytics, surveys, research, potential recruitment, employment, and other such related purposes. I understand that no personally identifiable information will be disclosed to outside parties, except as described in this application form. *I understand that all personal information related to my application for the Remedial Education Bursary is collected in accordance with applicable privacy legislation, for the purposes of administering my participation in the program, facilitating the evaluation process, funding verification, entitlement, disbursement of financial stipends, grants, reimbursement or waiver programs, statistical analytics, surveys, research, potential recruitment, employment, and other such related purposes. I understand that no personally identifiable information will be disclosed to outside parties, except as described in this application form.I consent to BC Care Aide & Community Health Worker Registry sharing personal information in my online Registry account with Health Match BC for the purpose of confirming my eligibility for this bursary. *I consent to BC Care Aide & Community Health Worker Registry sharing personal information in my online Registry account with Health Match BC for the purpose of confirming my eligibility for this bursary.If you have any questions about the application form or the use of this information, please contact us at info@choose2care.caSubmit