Brock University Students’ Union
Emergency Student Loan Program
Before completing this application, the Applicant MUST:
1)
Visit the Financial Aid Office and apply for:
o OSAP
o Canada Student Loan
o Bursaries
o Scholarships
2)
Read and fully understand the terms and conditions related to this loan
Applicant Name: ____________________________________
Student ID #:
_______________________________________
Date of application: _________________________________
Please attach photocopy of student card to this application
Cheque Amount
Cheque Number
Cheque Date
Repayment Date:
Please refer to loan terms on page 3
Student Signature confirming receipt of the cheque and repayment date:
Date: ______________
IMPORTANT: This program is not a bursary fund, and therefore, all monies
distributed from the fund must be paid back to the Emergency Student Loan
Program within the agreed upon time frame. The successful applicant must make
arrangements to repay their loan within one week of the repayment date at the
BUSU Reception Desk.
The applicant may visit the desk in person, e-mail reception@busu.net or call 905
688 5550 ext. 3568. Payments can be taken in the form of cash, cheque, debit, Visa
or MasterCard.
Please make cheques payable to Brock University Students’ Union.
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LOAN APPLICATION
First Name:
Last Name:
Permanent Address:
Student #:
Expected Graduation Date:
Local Address:
Permanent Telephone:
Cell Number:
Personal E-mail:
Brock E-mail:
S.I.N.:
Purpose of this loan:
Driver’s License #:
If for the payment of bills or rent, please attach copy of receipt.
Amount Requested:
OSAP received during previous semesters:
Fall:
Winter:
Spring:
Summer:
Canada Student Loans received during previous semesters:
Fall:
Winter:
Spring:
Summer:
Emergency Student Loans received during previous semesters:
Fall:
Winter:
Spring:
Other financial assistance (parental etc.)
Summer:
Have you visited the Brock University Financial Aid Office?
YES / NO
Are you currently employed?
Employer Name:
Employer Address:
Average Weekly Wage:
Date employment began:
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LOAN TERM
Repayment terms for BUSU Emergency Student Loans are no more than six
months.
For Loans made between:
May 1st – July 30th
August 1st – October 31st
November 1st – January 30th
February 1st – April 30th
Payment Deadline:
November 1st
February 1st
May 1st
August 1st
IMPORTANT PLEASE READ:
Applicants who do not pay their loan within the agreed term will have the
outstanding balance of the loan passed to Brock University’s Financial Office.
At this point the balance will be added as an amount owing to their student
account PLUS an administration fee of $15.00. Once this transfer has been
made, the balance will accrue interest at the monthly prevailing rate for unpaid
Brock University Student Accounts and may, if it remains unpaid, be passed to a
third party collections agency for recovery.
STUDENT DECLARATION
I declare that all the information herein is complete and true in all aspects, that I have
answered all the questions required of me on this form to the best of my knowledge, that I
shall be a student until the graduation date stated and that financial assistance is essential
to enable me to continue my education.
If my application is approved, I will use any assistance only for the payment of
educational and living costs directly related to the course of my study.
I understand that if I have not repaid the loan by the stated date above:
1. The outstanding balance of the loan will be passed to Brock University who will
charge my student account with the outstanding amount plus an administration fee
of $15.00.
2. Once the debt has passed to Brock University, if left unpaid, the balance will
accrue interest at the prevailing monthly rate charged to students by the Finance
Office and may delay my ability to register for classes or graduate upon
completion of my studies.
3. If the debt remains unpaid, Brock University will present my information to a
collections agency who will then manage the collection process.
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I hereby authorize the exchange of any and all materials provided herewith between
Brock University and Brock University Students’ Union Inc., until the loan and accrued
interest have been paid back entirely.
I hereby authorize B.U.S.U. to contact any credit reporting agency, banks, former or
current employer, relatives, landlords, or any persons with whom I have conducted
business to determine my worthiness of this loan.
I realize that failure to comply with this agreement and failure to repay this loan,
including any accrued interest, within the time frame agreed, will result in BUSU using
those means described above to assure that the moneys are recovered.
__________________________________
Name of Borrower (Printed)
______________________________
Vice President Finance
__________________________________
Name of Borrower (Signature)
______________________________
President
DISCLOSURE OF INFORMATION
Date: ___________________________________________________________________
To: Dean of Student Affairs
From: __________________________________
Brock Student ID #: _______________________
I, _____________________, hereby authorize you to release to the Brock University
Students’ Union, Inc., such information from my OSAP/CSL records and student records
as may appropriate to my application for an Emergency Student Loan. Specifically, you
may provide information relating to my enrollment status, OSAP/CSL eligibility, and
current and/or permanent address. This permission shall remain valid until I have repaid
the loan in full.
________________________________________
Emergency Student Loan Applicant
________________________________________
Vice-President, Finance and Administration
Brock University Students’ Union Inc.
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REPAYMENT INFORMATION
(to be completed by BUSU Receptionist)
Repayment Amount: _____________________
Outstanding Amount Owing: _______________
Payment Method:
Visa __ Mastercard __ Debit __ Cheque __ Cash __
Date Submitted: __________
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