Application Form Purpose of the Program To provide financial assistance to students of Ambrose University who demonstrate financial need in accordance with the criteria established for the Student Financial Assistance Fund. Source of the Funds The program is funded by donations from individuals who are interested in providing assistance to students who demonstrate financial need. Criteria 1. The student must be currently registered in full-time (9 credits/semester) at Ambrose University. 2. An accurate and complete Financial Assistance application will determine eligibility for assistance reflecting reasonable living expenses. 3. Returning students must not have any outstanding balances on their student account from previous year. Student Eligibility Process 1. Submit completed Financial Assistance Application to Financial Aid Coordinator’s office. 2. Students cannot receive Financial Assistance more than two times. 3. The Financial Aid Coordinator will allocate donated funds as indicated by the donor and based on a recipient’s eligibility. Funds will be used to cover any outstanding Fall tuition and fees to Ambrose and then may be used for personal needs. 4. Students receiving assistance will be required to repay funds awarded should they withdraw or be asked to withdraw from school. 5. A student’s level of eligibility for assistance may be affected by continuing and/or external scholarships received. Further Information If you require more information please contact the: Financial Aid Coordinator Ambrose University, 150 Ambrose Circle SW, Calgary, Alberta T3H 0L5 Telephone: 403-410-2900 Fax: 403-571-2556 E-mail: firstname.lastname@example.org ambrose.edu First Name Last Name Ambrose Student Number Social Insurance Number Email Address Phone Number Have you received Ambrose financial assistance before? Yes No Marital Status Single Married My spouse is a student Do you have any children? Yes No Please tell us the ages of your children Resident Status Canadian Resident Permanent Resident Student Visa Residence Please tell us what your living situation is Ambrose Residence Renting Home Other Program Please tell us what program you are enroled in Arts & Science School of Ministry Education Seminary Chinese School of Theology Other Other Program Year of study Credits to date Current Credit Hours September - December 3 6 9 12 15 Not Sure Current Credit Hours January - April 3 6 9 12 15 Not Sure Other Graduation Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year2015201620172018201920202021202220232024 Please tell us your vocational goals Section A: Projected Personal Income and Available Funding During Academic Year. Please record all monetary amounts in Canadian dollars. Total Personal/Employment Earnings (including EI) Amount/month x 8 months Total Spousal/Employment Earnings (including EI) Amount/month x 8 months Continuing Student Scholarships awarded last April For returning students only Other Scholarships Assistance from family, friends, and church Education Fund/RESP Savings Account Term Deposits/GICs/Bonds/Stocks/Mutual Funds Student Loans Awarded (Current Year) Student Aid Alberta Yes No Other Did you receive a federal (Canada Student Loan) grant? Yes No Did you receive as part of your loan, any of the following grants? Canada Low-Income Grant Canada Middle Income Grant Alberta Low-Income Grant Alberta Maintenance Grant Section B: Ambrose Educational Costs Please record all monetary amounts in Canadian dollars. Tuition & Mandatory Fees *this information can be found on your student registration system Books Theology/Seminary: $120/course; Arts & Science: $120/course) Educational Supplies/Equipment Child care Health Care (including dependents) *include health care outside of Ambrose student plan Section C: Allowable Monthly Expenses Your Household Status: Single & living with Parents $539 Single & not living with Parents $1,128 Married $2,174 Single, 1 child $1,991 Single, 2 children $2,583 Single, 3 children $3,175 Married, 1 child $2,766 Married, 2 children $3,358 Married, 3 children $3,950 Each Additional Child $594 Other Total Expenses Per Month Total Expenses x 8 Months Section D: Outstanding Educational Debts Ambrose Government Previous Loans Bank Loans Other Please specify what, and how much is owed. Applicant Statement Please tell us why financial assistance would be helpful to you based on your life's circumstances right now. Declaration of Applicant Yes I hereby declare that all information is complete and correct. I will notify the Financial Aid Coordinator if there is any change in the information recorded above. Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20152016201720182019 The personal information collected on or in conjunction with this form is collected under the authority of the Personal Information Protection Act (PIPA), the Statistics Act (Canada) and the Income Tax Act (Canada). It is required to determine your eligibility for admission and will be used to contact you regarding programs and services. It will form part of your record as an applicant, student, and alumnus and may be disclosed to academic and administrative units. Specific data elements may be disclosed to the Federal and Provincial Governments to meet reporting requirements. Since the Jason Lang Scholarship is a Student Aid Alberta Scholarship, this information will be given to Student Aid Alberta. If you have any questions about the collection, use or disclosure of this information, call the Student Aid Alberta Service Centre toll free at 1-855-606-2096 from anywhere in North America. You can also mail your questions to Student Aid Alberta, PO Box 28000 Station Main, Edmonton, AB T5J 4R4. All other information is considered confidential and will be used and disclosed in accordance with privacy legislation. For more information regarding the collection or use of this information, please contact the Privacy Compliance Officer (403-410-2000 or e-mail email@example.com).