Innis College, University of Toronto John W. Browne OSOTF Admission Award Application Instructions 1. Conditions: Awarded to an undergraduate student entering first-year studies in Arts and Science at Innis College. Awarded on the basis of financial need and to Ontario Resident. Preference will be given to students who, by their leadership, have contributed to the life of their high school and/or community. 2. A statement outlining your extracurricular activities, a copy your résumé, and this completed budget form should be returned to the Innis College Registrar’s Office, 2 Sussex Avenue, Room 117, Toronto ON, M5S 1J5. 3. Value: Annual Income 4. Application deadline: EXTENDED TO 1 May 2015. 5. For complete award details, see innis.utoronto.ca/current-students/scholarships/awards-table and search “Browne”. Personal Information Name In Full Sessional Address (May to August 2015) including Postal Code Telephone Home Address (including Postal Code) Expiry date at this address Same as above, or Telephone Email Marital Status Single Married Other Status in Canada Canadian Citizen Permanent Resident Student Authorization Other Academic Information U of T Student Number Social Insurance Number Admission Category Commerce Computer Science Mathematical & Physical Sciences Life Sciences Humanities Social Sciences Program(s) of Interest (e.g., Psychology, Cinema Studies, Zoology etc.) The following information will help the Bursary Subcommittee of the Innis College Council understand more fully your financial situation. Please provide the requested additional information. 1. Family Information To be completed by all students who have not been out of secondary school for more than four years, and by all married students. Gross annual income Father/Guardian/Spouse Mother (circle one) Mother $_________________ $_________________ Number of Dependents in the family ________ Number attending University ________ If there are special circumstances which limit the support provided by your family, please provide details in the Additional Information section below. 2. Employment Information Summer School Year $_________________ Total Summer Earnings Amount saved for University Expenses $_________________ If you were not employed, or were unable to save a reasonable portion of your earnings, please explain below. Are you working part-time during the current academic year? Yes If yes, how many hours do you plan to work per week? _________________ No If no, please elaborate under Additional information. 3. Government Assistance Have you applied for O.S.A.P., Canada Student Loan, or other government aid assistance for the current academic year? Yes No If your answer is no, please elaborate under Additional Information. 4. Motor Vehicle Do you own a motor vehicle? Yes No If yes, please indicate: model _________________ & year _________________ and explain its necessity under Additional Information. 5. Budget Outline Please provide the following budget for the eight months period (September to April) of the academic year you are entering. Married students should indicate their total family income (after tax and other compulsory deductions) and total family expenses. FINANCIAL RESOURCES Income source Bank Balance (all accounts) by the end of Aug. including summer savings Income from part-time work during the academic year Grants/Scholarships (including UTAPS) OSAP or other government student aid Spouse’s income (net) Parental Support/support payments Child tax credit/ GST rebates/orphan’s benefits ESTIMATED EXPENSES Estimated or Actual (A/E) Amount ($) Expenses type Tuition Books & supplies Rent/Residence Utilities (e.g. hydro, water) Groceries Transportation Toiletries/personal care Laundry Assets which can be liquidated Child Care Other income not declared above Telephone Total Income Cable TV/ entertainment/ recreation Clothing Credit Card debt or loan (monthly payment) if any Other: provide details under Additional Information Total expenses $/month (if applicable) Total $ for 8 months Based on the information provided on the previous page, your calculated financial need is ________________ (Total Expenses) - _________________ (Total Resources) = _________________ (Need) If the difference between resources and expenses exceeds $1,000, ensure that you explain under additional information (you may attach a separate letter) how you plan to meet this shortfall. Traditionally students are assisted by their parents/family in pursuing their post-secondary studies. This may be in the form of direct financial or non-monetary aid such as free room and board. If you are receiving no or minimal financial assistance (i.e., less than 10% of budgeted need) or other help from you family please explain why this is the case. Additional Information (use separate page instead if needed) Declaration I hereby certify that the information provided on this application is, to the best of my knowledge, true and complete, and I authorize the release of the information contained herein to the appropriate Grant Selection Committee. Some grants are funded by private donors who wish to receive limited information about the recipient(s). This could be general, biographical and/or academic in nature. Do you agree to the release of such information? Yes No The University of Toronto respects your privacy. The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy or contact the University's Freedom of Information and Protection of Privacy Office at 416-9465835, Room 201, McMurrich Bldg., 12 Queen's Park Crescent, Toronto, ON, M5S 1A1 By applying for this award, I give permission to Innis College (including the Principal’s Office, the Associate Director for Alumni and Development, and the Registrar’s Office), in the event of my receiving an award, to publish my name recognizing my achievement, in both print and online. In the event of receiving an award, I also authorize Innis College, University of Toronto, to take a photo/video of me at any event honouring award recipients, and authorize the use of such an image/video in any Innis College publication, advertisement or website. I will not be paid to appear in such a photo/video and will not receive any fees in the future for the use of the photo/video. Signature Date
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