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