STUDENTS’ UNION
Local 109 Canadian Federation of Students
University of Toronto Mississauga, 3359 Mississauga, ON L5L 1C6 (905) 828-3703 | Office (905) 569-4714 | Fax
U.T.M.S.U. Book Bursary Fall 2015 Application Form
Your Students’ Union offers a book bursary, every year, to assist students in meeting the high cost of
financing their post-secondary education. The bursary is a reimbursement for some of the costs associated
with the purchase of books during the 2015 fall academic term. Bursaries come as reimbursement cheques
from the Student Union.
Please return this form, along with the required documents to Eva Mitre, Bursary Coordinator during
office hours to the U.T.M.S.U. office: Student Centre, Room 115 | Hours: Monday-Friday 9am-5pm.
Please submit filled form, with all the supporting documents by November 6tht, 2013 by 5PM.
This award is based solely on financial need. The collected information is used to determine eligibility and
will remain strictly confidential. Late applications WILL NOT be accepted.
Applications submitted late and/or without receipts will not be considered. For more information visit
www.utmsu.ca or email bursary@utmsu.ca
PLEASE COMPLETE ALL SECTIONS IN FULL (complete sections A-E and print)
(A) Personal Information (all fields are mandatory):
Marital Status (circle)
Single / Married / Sole Support
Parent / Other
No. of Dependents
Status in Canada (circle)
Canadian Citizen / Resident /
Int’l Student / Other
Last Name
First Name
Middle Name (if any)
Student Number
Year of Study (circle)
1 2 3 4 5 6 Other ____
Program/Area of Study
Number of Credits enrolled in
for 2015-2016
Are you graduating this year? (circle)
Yes / No
Street name and address
Apt #
City
Province
Postal Code
Home Telephone
Alternate Telephone
Email (UToronto) and
Alternative email
(B) Budget Outline
Please try to include amounts as accurately as possible (use estimates where actuals are not available).
Financial Resources
Income/Loans for the Summer session (September 2015- April 2016)
Income source
Amount ($)
Bank Balance (all accounts)
Income from part-time work (September 2015-April 2016)
Parental support/support payments
Grants/Bursaries/Scholarships
OSAP or other loans
Other government student
aid or benefits
Other income (please specify)
Total Resources
Estimated Expenses
Expenses for the Summer session (September 2015- April 2016)
Expense Type
Amount ($)
Tuition + Books
Rent + Utilities
Groceries
Transportation
Toiletries/Personal care
Childcare
Telephone
Entertainment
Current Debt (credit cards loans, lines of credit)
Other expenses (please specify)
Total Expenses
If further clarification is necessary please include it in your personal statement.
***************Important************
Document Checklist (please attach to this form):
Note: your application will not be considered if ALL the supporting documents are not provided.
(C) Statement (please attach separately):
 On a separate sheet, state in 150 words or less, why you are eligible and need this bursary.
(D) Document Checklist (please attach to this form):
 Additional supplementary documentation (i.e. acknowledgements of subsidy, enrolment, waitlist
status)
 Bank statements: including credit card accounts, credit card balances, and savings.
 Printout of ROSI timetable including financial invoice from ROSI.
 OSAP Notice of Assessment/print-out of assessment
 Receipts of all book purchases need to be attached along with the form.
 Note: Additional documentation may be required, for better assessment.
(E) Please attach the list of required books for every course, along with the prices (you paid) for
the books.
Note: Additional documentation may be required for a fair assessment
I consent to providing any additional information if contacted by the bursary coordinator.
______________________
Initials of the applicant
________________________
Date
(F) Declaration
Declaration
I hereby certify that the information provided on this application is, to the best of my knowledge, true
and complete. I understand that my failure to provide complete information may prevent me from
receiving assistance now or in the future. I authorize the release of the information contained herein to
the Selection Committee.
Signature: ____________________________________________Date:____________________
***You will be asked to put your complete application alongside all supporting documents, in a
folder/envelope which will be provided to you upon your submission. Please DO NOT SEAL this
folder/envelope.