2020/2021
SECTION 4: APPLICANT DECLARATION
This is the declaration and Canada Revenue Agency consent form. Read the declaration carefully. If you do not understand it, ask for assistance at your
financial aid office.
I am applying for financial assistance under the terms and conditions of the Ministry of Advanced Education, Skills and Training.
I. I understand that:
1. It is my responsibility to make sure the information on this application, and/or all the documents forming part of it is accurate;
2. The post-secondary institution will determine the amount of money I may be eligible to receive;
3. It is against the law to make false or misleading statements on this application or all documents forming part of it;
4. If I do not provide complete, accurate information or if I obtain or attempt to access financial assistance by fraudulent means, I will be denied the
Adult Upgrading Grant;
5. All information is subject to audit and verification;
6. If I receive money and then it is discovered that my application, or documents forming a part of it, is not accurate, I may be required to repay all or
part of the money. I will be required to do this if the mistake was made by me, my spouse/common-law partner, parent(s), legal guardian; and
7. If I receive the Adult Upgrading Grant, a portion or all of the money may be sent directly to my school to pay educational fees.
II. I understand that by signing below it means:
1. I have read the instructions provided with this application;
2. I have accurately answered all questions on the application and all documents forming a part of it;
3. I certify that all information is complete and accurate and I have not altered or added to any of the pre-printed application;
4. I need student financial assistance to continue my education;
5. For the purposes of research and verifying information about this application and related documents, I agree to the collection, use and disclosure
of my personal information between the Ministry of Advanced Education, Skills and Training, educational institutions, financial aid offices, First
Nations governments/bands, and federal, provincial, municipal ministries/departments/agencies. This consent takes effect when I sign this
Declaration.
Collection and use of information. The information included in this form and authorized above is collected and managed in accordance with Section 26 of
the Freedom of Information and Protection of Privacy Act and under the authority of the Canada Student Financial Assistance Act, R.S.C. 1994, Chapter
C-28 and the Ministry. The information provided will be used to determine eligibility for a benefit through the Ministry. If you have any questions about the
collection and use of this information, contact Ministry of Advanced Education, Skills and Training, PO Box 9173, Stn Prov Govt, Victoria, BC V8W 9H7, call
1-800-561-1818 (toll-free in Canada/U.S.) or 250 387-6100 (outside North America).
(IMPORTANT DOCUMENT – READ, SIGN AND DATE )
CANADA REVENUE AGENCY CONSENT
For the purpose of verifying the data provided in this application for student assistance, I agree to the release, by the Canada Revenue
Agency, to the Ministry of Advanced Education, Skills and Training (or a person delegated by the ministry), of taxpayer information from
any portion of my income tax records that pertains to information given by me on any Ministry application. The information will be relevant
to, and used solely for the purposes of determining and verifying my eligibility for the Adult Upgrading Grant. This authorization is valid for
the two taxation years prior to the year of signature of this consent, the year of signature of this consent and for any other subsequent
consecutive taxation year for which assistance is requested.
(IMPORTANT DOCUMENT – READ, SIGN AND DATE )
APPLICANT SIGNATURE PRINT NAME DATE SIGNED
MUST BE SIGNED PRINT HERE
Y Y Y Y M M D D
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APPLICANT SIGNATURE PRINT NAME DATE SIGNED
MUST BE SIGNED PRINT HERE
Y Y Y Y M M D D
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