Fillable 20/21 S4 Federal/Provincial Grant for Post-Secondary Students with (Alberta Student Aid)

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20/21 S4 Federal/Provincial Grant for Post-Secondary Students with (Alberta Student Aid)

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The 20/21 S4 Federal/Provincial Grant for Post-Secondary Students with (Alberta Student Aid) form is 5 pages long and contains:

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  • 28 check-boxes
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Country of origin: CANADA
File type: PDF

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Schedule 4 Last revised December 2020
Applicant’s Signature Today’s Date Telephone Number (format: 999-999-9999)
Day Month Year
Before applying…
Talk with a Disability Advisor/Reviewer at your school about
your educational goals and what kind of supports may already
be in place at your chosen institution.
What permanent disability student aid could I be
eligible for?
• Canada Student Grant for Students with Permanent
Disabilities: $2,000 per loan year to assist you with
education and living costs.
• Canada Student Grant for Services and Equipment for
Students with Permanent Disabilities: Up to $20,000 per
loan year to help you with exceptional education related
costs such as assistive services or equipment.
• The Canada Student Grants program may cover up to 75%
of the cost of a Learning Assessment (up to a maximum of
$1,700 per loan year) if the assessment conrms you have
a learning disability.
When should I apply?
It is best to apply by early July for September study. You can
apply at any time of the year but Alberta Student Aid must
receive your application, including Schedule 4, at least
30 days before this application’s session end date.
What is a reduced course load?
Your disability may limit you from taking a full course load. If
so, you can carry as little as 40% of a full course load and still
apply for full-time student aid. Your Schedule 4 must be signed
by an ofcial at your school to conrm that you are taking a
reduced course load. If you are studying part-time, you may
also be eligible for permanent disability funding. A part-time
application can be printed from studentaid.alberta.ca
Tips for completing your Schedule 4
• All $ amounts must be submitted in Canadian dollars.
• If you apply for student aid online, you must still submit
a paper Schedule 4.
• Attach all required documentation to your Schedule 4.
• The Disability Advisor/Reviewer at your school is required
to sign Section 4 of your Schedule 4.
• If you are applying for a reduced course load, Section 3 of
your Schedule 4 must be signed by an ofcial at your school.
The Disability Advisor/Reviewer at your school may also
be authorized to sign this section. Check with the advisor/
reviewer rst for assistance and further instructions.
Do I need to keep receipts?
If you receive student aid for assistive services and equipment,
you must submit your receipts to Alberta Student Aid by the
end of your current study period to show that the student aid
you received was used as intended. Write your Social Insurance
Number (SIN) and your name on each receipt.
If you do not use all of the student aid, you must return the
unused funds to Alberta Student Aid. Make your cheque or
money order payable to Government of Alberta. If you do not
send receipts or return the unused funds, you will be in an
overaward situation.
If you have a documented permanent disability and are attending post-secondary studies, you may be eligible to receive more
student aid. You must include medical documents with your first application.
What is a Permanent Disability?
A permanent disability is a functional limitation caused by a physical or mental impairment that restricts the ability of a person
to perform the daily activities necessary to participate in studies at a post-secondary level or labour force, and is expected to remain
with the person for the person’s expected natural life.
If I receive a disability grant for services or equipment for post-secondary students with permanent disabilities, I hereby agree to
provide, by the end of my current study period, receipts which will show that the student aid was spent for its intended purposes.
Include your name and Social Insurance Number on all receipts and upload electronically.
Applicant Agreement
Federal/Provincial Grant for Post-Secondary
Students with Permanent Disabilities 2020/2021
Schedule 4
Information and Instructions
20/21 S4
✗ SIGN HERE
Upload Schedule 4 and Receipts
Send electronically: 1. Visit studentaid.alberta.ca 2. Sign in
to your account 3. Submit securely using Upload Electronic
Document(s)
Return Unused Funds
Online Banking: Payee “Alberta Student Aid – Grants” and
account number Alberta Student Number
Cheque or money order payable to the Government of
Alberta: Mail to Alberta Student Aid, Attention Disability Grants,
PO Box 28000 Stn Main, Edmonton AB T5J 4R4
Schedule 4 Last revised
December 2020
Schedule 4
Type of Disability Documentation Required
Deaf, Hearing Impaired
• Audiologist report, or
• Letter from a physician with an explanation of the degree of hearing loss
Blind, Visually Impaired
• Specialist report, or
• Letter from a physician with a description of the functional limitations
Learning Disability
• Psycho-educational report from a Psychologist, or
• Neuro-psychological report
Speech • Speech language pathologist report
Mobility/Agility Impairment
• Specialist report, or
• Letter from a physician with an explanation of the nature of the mobility/agility
impairment (functional limitation)
ADD / ADHD
• Psychologist report, or
• Neuro-psychological report, or
• Letter from a psychiatrist, or
• Letter from a physician with details about the diagnosis
Psychiatric or Psychological
• Psychologist report with a DSM diagnosis, or
• Letter from a psychiatrist with a DSM diagnosis, or
• Letter from a physician with details about the diagnosis including the DSM
Autism, Asperger, Rett
• Psychologist report, or
• Letter from a physician with details about the diagnosis
Brain Injury/Cognitive Impairment
• Neuro-Psychological report, or
• Brain injury/cognitive impairment report/assessment
Other Permanent Disability such as:
• Chronic Fatigue: a detailed letter from physician
• Irlen Syndrome: assessment report from a certied Irlen Screener
What documents do I need to include?
You must include:
• An Application for Financial Assistance available
at studentaid.alberta.ca
• A Schedule 4 if this is your rst application. You need
to submit a Schedule 4 with each application if you are
requesting services and equipment, and/or studying at a
reduced course load (40-59%).
• Proof of your permanent disability – Medical documents
identifying your permanent disability and describing how it
restricts your ability to participate in post-secondary studies
must be submitted with your rst application as a student with
a permanent disability. The documents may include:
- Copies of a medical letter,
- A learning disability assessment, or
- A document proving you are in receipt of federal and/or
provincial disability assistance such as AISH.
• An estimate of Assistive Services and Equipment/Assistive
Technology – You must submit estimates and quotes for both
Assistive Services and Equipment/Assistive Technology. New
estimates and quotes will be required each additional time you
request funding.
• Learning Assessment fee – If an assessment conrms you
have a learning disability, you may be reimbursed up to 75%
of the cost of this service (up to a maximum of $1,700 per loan
year). The date of the assessment must be no earlier than six
months before you start your studies. You must supply
a receipt showing that you paid for this service.
TIP: Check with the Disability Advisor/Reviewer at your school
rst. They can provide information about assistive services
and equipment.
Summary of Disability Documentation Required
Information and Instructions - Continued
Schedule 4 Last revised
December 2020
Page 1
Application ID
Enter your current study period
start and end dates for the
2020/2021 school year.
This schedule is complete only if all required documentation is submitted.
Before you start, read the information on the Information and Instructions pages.
Advanced Education is collecting this personal information under the authority of section 33(c) of the Freedom of Information and Protection
of Privacy Act (Alberta) to determine and verify the Applicant’s eligibility for nancial assistance, to administer (including research, statistical
analysis and evaluations) and to enforce student nancial assistance programs in accordance with the Student Financial Assistance Act
(Alberta), the Canada Student Loans Act and the Canada Student Financial Assistance Act, each as may be amended from time to time.
The use and disclosure of your personal information is managed in accordance with the Freedom of Information and Protection of Privacy
Act (Alberta). If you have any questions about the collection, use or disclosure of this information, call the Alberta Student Aid Service
Centre toll free at 1-855-606-2096 from anywhere in North America. You can also email your questions to the Alberta Student Aid Privacy
Ofcer at ae.abstudentaidfoip@gov.ab.ca.
To complete a fillable form: 1. Save to your desktop. 2. Complete form. 3. Save nal. Check, then submit. Never complete in a browser.
Learning Assessment Fee (enter 75% of the cost up to a maximum of $1,700)
Section 1 – Assistive Services
$
φ
Note Taker
$
φ
Tutor with specific course
knowledge (resumé required)
1
$
φ
Academic Strategist
(resumé required)
2
φ
Educational Attendant Care
(while in school)
φ
Specialized Transportation
(to and from school only)
φ
Other Services
$
$
Applicant’s Last Name
Applicant’s First Name Initials
Start
Day Month Year
End
Day Month Year
$
$
$
Federal/Provincial Grant for Post-Secondary
Students with Permanent Disabilities 2020/2021
Schedule 4
20/21 S4
Social Insurance Number
φ
Interpreter (Oral, Sign, CART)
$
(You must attach
your receipt.)
$
$
Enter TOTAL amount for the current study period:
1
For tutor rates over $25 per hour, resumé/credentials must be provided.
2
A resumé/credentials must be provided for all Academic Strategy requests.
Comments for Requested Assistive Services:
When requesting Assistive Services, you must submit cost estimates and cost breakdowns. Depending on the requested
service, this may include: number of hours per week, number of weeks, cost per hour, and number of courses.
Schedule 4 Last revised
December 2020
Page 2
Federal/Provincial Grant for Post-Secondary
Students with Permanent Disabilities 2020/2021
Schedule 4
Today’s Date
Day Month Year
What is the student’s percentage of a full course load? %
Reduced Course Load (to be completed by the Disability Advisor/Reviewer or Financial Aid Ofcer or Registrar ONLY if you are
enrolling in between 40% to 59% of a full course load and want to be considered for full-time student aid)
Signature of School Ofcial
✗ SIGN HERE
Printed Name of School Ofcial
Telephone Number (format: 999-999-9999)
Section 3 – For Educational Institution Use Only - Do Not Write in this Area
When requesting Equipment/Assistive Technology, you must submit a copy of an estimate/quote for each item.
Enter the description and amount for the current study period:
φ
Electronic Reading/Writing Software (e.g. Kurzweil, Dragon)
$
φ
Assistive Software (e.g. Inspiration)
$
φ
Digital Recorder/Smartpen
$
φ
Assistive Devices for the Visually Impaired
$
φ
Assistive Devices for Hearing
$
φ
Alternate Formats
$
φ
Computer/Laptop/Tablet
$
φ
Other Equipment
$
$
$
$
Section 2 – Equipment/Assistive Technology
Comments for Requested Equipment/Assistive Technology:
click to sign
signature
click to edit
Schedule 4 Last revised
December 2020
Page 3
Federal/Provincial Grant for Post-Secondary
Students with Permanent Disabilities 2020/2021
Schedule 4
Nature of Permanent Disability (Documentation regarding the nature of permanent disability must be attached if not previously
provided.) Please check appropriate box(es):
Section 4 – For Use by Disability Advisor/Reviewer Only - Do Not Write in this Area
TOTAL recommended services/equipment
Attach documentation itemizing the assistive services
and/or equipment that covers the above.
$
φ
ADD/ADHD
φ
Psychiatric or Psychological
φ
Autism, Asperger, Rett
φ
Brain Injury/Cognitive Impairment
φ
Other Permanent Disability (see Information and Instructions
for definition of permanent disability)
φ
Deaf, Hearing Impaired
φ
Blind, Visually Impaired
φ
Learning Disability (list below)
• _______________________
• _______________________
• _______________________
φ
Speech
φ
Mobility/Agility Impairment
Internal Comments:
Direct Telephone Number
of Disability Advisor/Reviewer (format: 999-999-9999)
Extension
Today’s Date
Day Month Year
Signature of Disability Advisor/Reviewer
✗ SIGN HERE
Email Address of Disability Advisor/Reviewer
Name (please print)
$
$
$
CSG-PDSE: TOTAL:GFD:
Reviewer:
Date
Day Month Year
φ
CSG-PD only
φ
Additional Funding
φ
Reduced Course Load
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2021 S4 FederalProvincial Grant for Post-Secondary Students with (Alberta Student Aid)

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Completed 23 December 2020

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