Scholarship Application and Budget Form

(Former OTSS)
Please print legibly.
Name _______________________________________________________________________________________________
Address ___________________________________________________ City ______________________________,Ontario
Postal Code ___________________ Phone _____________________ Alternate _________________________________
Email ________________________________________________________________________________________________
Humber.Student.No.________________________________ Social Insurance No. _________________________________
Humber Program __________________________________ Entering Semester _____Campus: North ___ Lakeshore ___
Scholarship you are applying for __________________________________________________________________________
Indicate status  Canadian Citizen ____ Permanent Resident ____ Ontario Resident ** ____Protected Person * ____

Please complete the below listed budget for your academic year (e.g. September to April, May to August, September to August)
Expenses for one month Financial Resources (for academic year)
$ $
Rent …………………………………... ______________ Savings at beginning of school year………_______________
Utilities ..……………………………… ______________ Part-time earnings during school year…….
_______________
Telephone ..…………………………… ______________ Contribution of Parent/Spouse…………… _______________
Other (Specify) ___________________ ______________ OSAP Loan………………………………. _______________
Food ………………………………….. ______________ Academic Awards: Bursaries …………… _______________
Personal/Household supplies ………… ______________ Academic Awards: Scholarships………… _______________
Transportation ………………………... ______________ Government Income (Specify) _________ _______________
Medical/Dental (uninsured only) …….. ______________ C.P.P./Child Tax/E.I./Voc. Rehab……….. _______________
Prescriptions ………………………….. ______________ Monetary Gifts…………...……………… _______________
Eye Glasses/Contact Lenses ………….. ______________ Other (Specify) ____________________________________
Clothing ………………………………. ______________

Total Expenses for one month $ $_____________ Total Financial Resources $_____________
$

Total Expenses for one month $____________ Multiplied by the # of months in your academic year …. $ ____________
Add tuition fees ………………………… _____________
Add books/equipment ………………... _____________
Total Expenses …………………………. _____________
Total Expenses $ _______________ Less Total Financial Resources $ ________________ = $ ____________

Declaration by Applicant
The applicant must be a Canadian Citizen, a Permanent Resident, or a Protected Person*. Funding is restricted to students who are enrolled in
provincially-assisted postsecondary programs who meet provincial residency requirements as set out in the Ontario Student Assistance Program’s
2006-2007 Student Eligibility and Financial Need Manual**. A student’s eligibility for student aid from an institution’s financial aid scholarships will
depend on his/her financial need as determined by the institution’s policies on financial need. For information about and scholarships contact
student.awards@humber.ca

Pursuant to section 39(2) of the Freedom of Information and Protection Act I, _____________________________, hereby consent to
A) The use of personal information such as name, program and SIN number obtained by the Advancement & Alumni Relations office pertaining to
my application for this award/scholarship. Includes the use of thank you letters.
B) The use of any photograph, taken by College personal which contains me in it
C) The requisition and provision of any information held by Humber College relating to my application including but not limited to personal
evaluations and transcripts to the award donor or selection committee.

I certify that to the best of my knowledge the above information is true and correct and that I require additional funds for my studies at the Humber
College Institute of Technology and Advanced Learning. I understand that my name and/or photograph may be used for promotional purposes.

Date Applicant’s signature

* A Protected Person is defined under subsection 95(2) of the Immigration and Refugee Protection Act (Canada). Protected Persons are individuals who have been
issued a Protected Persons Status Document. ** Ontario residency requirements stipulate that the applicant has always resided in Ontario or Ontario is the last
province the Applicant resided in for 12 consecutive months without being a full-time, postsecondary student. Rev. 2009