FOOD SUPPORT & RESOURCES APPLICATION
PSAC Local 610
University of Western Ontario, Somerville House, Room 1313, London, ON N6A 3K7
Phone: 519-661-4137 Email: staffpsac610@gmail.com Fax: 519-850-2998
w
ww.psac610.ca
UWO EMAIL
(ALL INFORMATION IS CONFIDENTIAL)
The Food Support & Resources Fund is intended to aid members who are experiencing unexpected financial need or an emergency that
diverts income from their food budget. With a limited budget, the fund is not sufficient to address chronic need. Given these limited
resources, not everyone will be approved.
Members with personal or medical emergencies should also consider applying for PSAC 610's Financial Assistance Fund and Extended
Health Plan. Please review the application criteria for all of our benefits at www.psac610.ca/benefits
. Each successful applicant will
receive $75 in vouchers, plus $25 for every dependent in their household (e.g., spouse, children) to a maximum of $175.
Members who live with a partner who is also employed as a TA or Post-Doc at Western shall apply together on one form. Successful two-
member applications receive $75 for each member (total $150), plus $25 for dependents to a maximum amount of $175.
Member Information
Are you currently employed as a TA or PD?
Yes
No
If not, when was the last time you were employed as a TA or PD? (month/year)
Are you a Canadian / permanent resident or international student or PD?
Canadian/PR International
Income Information
Potential sources of income include: Teaching Assistantship, Research Assistantship, Postdoctoral
Fellowship, WGRS/Department Funding, External Scholarships, Off-Campus Employment, Loans, and Child
Care Benefits.
What is your estimated annual income? $
Household Information
Do you have a domestic partner?
Yes
No
If yes, is s/he also a TA or PD at The University of Western Ontario?
If yes, please provide their UWO email address:
If your partner is working, what is their estimated total income
? $
Yes No
Do you have children?
Household Expenses
Yes
No
If yes, how many?
Expenses include the following costs of living: Tuition Fees, Books/Other School-Related Materials, UHIP
Fees, Study Permit Fees, Rent/Mortgage, Utilities - Heat, Hydro, Water, Telephone, Internet, and Television -
Groceries, Child Care Expenses, and Transportation.
What are your estimated annual expenses? $
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