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. Winter 2016 Book Bursary Application Form(s)
Your Students’ Union offers bursaries every year to assist students in meeting the high cost of financing their postsecondary education. The bursary is a reimbursement for some of the costs associated with the purchase of books or other financial needs during the 2015 fall and 2016 winter academic term.
Please return this form, along with the required documents to the Bursary Coordinator during regular office hours:
U.T.M.S.U. office: Student Centre, Room 115 | Hours: Monday-Friday 9 am -5 pm.
Please submit the completed form, with all the supporting documents by February 12th, 2016 by 12PM.
This award is based solely on financial need. The collected information is used strictly 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
For any questions please email bursary@utmsu.ca
Deadline is
February 12th, 2016 by 12 PM.
PLEASE COMPLETE ALL SECTIONS IN FULL (complete sections A-E and print)
(A) Personal Information (all fields are mandatory):
Marital Status (circle) No. of Dependents
Single / Married / Sole Support
Parent / Other
Last Name First Name
Status in Canada (circle)
Canadian Citizen / Resident /
Int’l Student / Other
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).
Income/Loans for the Summer session (September 2015- April 2016)
Income source
Bank Balance (all accounts)
Amount ($)
Income from part-time work (September 2015-April 2016)
Parental support/support payments
Grants/Bursaries/Scholarships
OSAP or other loans
Other government student aid or benefits
Other income (please specify)
Total Resources
Expenses for the Summer session (September 2015- April 2016)
Expense Type Amount ($)
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.