Senior citizen bursary application form

��ú students who will be 65 years of age or older prior to the first day of classes in the term that their studies commence may be eligible for a bursary subject to the following conditions:

Applicant must be admitted to the university and registered in full-time or part-time studies for credit or audit.
Apply as early as Aug. 1 for the academic school year when you have completed your registration for courses. This application must be received no later than the respective term bursary application deadlines: fall term — Nov. 1; winter term — Mar. 1.
Applicant must declare financial need.

Find out more information under Senior Citizen Bursary FAQ.

Please be advised that your application form will remain confidential and only be used for the purpose of assessing the bursary application.

Before you begin to fill in this form, make sure you have:

student ID number
estimated gross income and spouse's estimated gross income (if applicable) for the current year
other income (e.g. rental, annuity)
amount of any student loans and bank loans or line of credits for educational purposes
anticipated earnings and other sources of income
anticipated expenses (rent/mortgage, telephone/heat/hydro, groceries, tuition, transportation, etc.)

All sections of this application must be completed, including the detailed budget.

This form is best viewed on a desktop, or a laptop computer. Mobile devices such as smartphones and tablets will not provide an optimal display.

* Indicates required field

Personal information

Last name *

First name *

Student ID *

Phone number *

E-mail *

Address *

Address 2

City/Town *

Province/State

Postal Code/ZIP

Country *

Citizenship status

Canadian

Permanent resident

Other

If other, please specify

Marital status

Married

Separated

Divorced

Single

Widowed

Common law

Spouse/partner information

Married or common law applicants must provide income and resources for both spouses/partners.

Name

Address (if different from above, else, leave blank)

Dependents

Dependent information

Please add details of the applicant's dependents using the 'Add' function below as required.

Re-order	Full name	Age	Relationship to applicant	Weight	Operations
	Full name *This field is required.	Age *This field is required.	Relationship to applicant	Item weight

more items

Annual budget

Please include all study periods in the academic school year.

Annual budget *

Resources	Expenses
Anticipated earnings during study periods *This field is required. CAD	Rent/mortgage during study periods *This field is required. CAD
Third party support during study periods *This field is required. CAD	Telephone, heat, hydro during study periods *This field is required. CAD
Other sources of income during study periods *This field is required. CAD	Groceries during study periods *This field is required. CAD
If applicable, student loans and grants CAD	Tuition and fees *This field is required. CAD
If applicable, bank loan or line of credit CAD	Books *This field is required. CAD
Bank balance one month prior to start of term on all accounts *This field is required. CAD	Miscellaneous and other expenses during study periods *This field is required. CAD
	Transportation expenses during study periods *This field is required. CAD
Total study period resources *This field is required. CAD	Total study period expenses *This field is required. CAD

Applicant's declaration and authorization

Please read and check the box below if you agree with the following statements:

I understand that submission of this application does not guarantee a bursary will be awarded and that I will be notified, in writing, when a decision is made on this application.
I understand and accept that the following information must accompany this application.
- Copies of my student loan assessments (if applicable) for the academic year and/or any bank loan documents for the academic year.
- Bank account statements (include statements for all your bank accounts.) Statements must show transactions over the past 30 days prior to submitting this application. Statements showing account balances only will not be accepted.
I understand and accept that the University reserves the right to require additional information to complete the assessment of this bursary.
I declare that all information and documentation provided is, to the best of my knowledge, a complete and accurate statement of my financial status, and I hereby request consideration for assistance from the funds made available for this purpose by the University.
I authorize the release by ��ú University of information about any financial assistance that may be awarded to me as a result of this application, upon request by any federal or provincial student financial aid office to which I make an application for financial assistance, or upon request by a donor funding the bursary.
I authorize the University to contact my sources of funds, and to verify information provided, if this is deemed to be necessary.
I understand and accept that failure to disclose complete and accurate information may result in my bursary application being revoked.

I have read and agree with the above statements. *

Additional information

Please check as applicable.

I am sending additional information under separate cover.

I am sending information by

E-mail to financialaid@mta.ca

Fax

Dropping off or mailing a paper copy to the registrar's office

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