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Employment and
Social Development Canada
Emploi et
Développement social Canada
ESDC SDE0031 (2021-06-FINAL) E Page 1 of 6
PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022
CANADA STUDENT FINANCIAL ASSISTANCE
PROGRAM
Province / Territory in which you are a resident
Please see Page 5 for Residency definition
Student Number (if applicable) Social Insurance Number (SIN)
A. Personal Information
Family Name Given Name
Address While at School (Street, Apartment Number, Rural Route, Post Office Box)
City / Town Province / Territory Postal Code Country
Telephone Number While at School Cell Phone Number While at School Date of Birth (YYYY-MM-DD)
Gender
M F
Another
Gender
Citizenship Status
Canadian Citizen Protected Person
Permanent Resident
Person registered as an Indian under the
Indian Act who is not a Canadian citizen
Additional Citizenship Status documentation is required:
If you selected Permanent Resident, you must attach a copy of your Permanent Resident Card.
If you selected Protected Person, you must attach a copy of a valid Protected Persons Status Document (if available), OR a copy of
the Immigration and Refugee Board of Canada's Notice of Decision document, OR a copy of Immigration, Refugees and Citizenship
Canada’s Verification of Status document. If required documentation is not included, there will be delays in processing your
application.
Marital Status
Single Married Common-Law
Do you wish to declare yourself as a student with a permanent disability?
If yes, you must attach proof of your permanent disability (medical certificate, learning
disability assessment). If documentation of your disability has previously been confirmed
when applying for a federal or provincial student loan, you are not required to submit
additional proof of your disability.
Note that learning disability assessments done before the applicant’s 18th birthday are valid
for only five years. If older than five years, a second learning disability assessment will have
to be done. This second assessment however, is deemed permanent.
Yes No
What is the total weekly amount you expect to pay for child
care (day-care) for your children, 11 years of age or younger
(or 12 and older, who have a permanent disability), during
class hours for your current / proposed study period?
$
How many dependants do you have living with
you full-time during your study period in each
age group?
0 - 11 years
of age
12 years and older
who do not have a
permanent disability
12 years and older
who have a
permanent disability
NOTE: For persons 18 years of age or older to be
considered dependent, they must be full-time secondary or
post-secondary students, or permanently disabled. Persons
who have been out of high school for at least 4 years or
have been in the work force for at least 12 months in a row
on 2 or more occasions may not be considered dependent.
Please note that if you are applying in the Territory of Yukon and have dependants,
you are required to submit a copy of the birth certificate for each dependant.
Permanent Address (Street, Apartment Number, Rural Route, Post Office Box)
City / Town Province / Territory Postal Code Country
Permanent Telephone Number Permanent Cell Phone Number Email Address of Student
Have you ever studied part-time AND received a grant and/or a loan for those studies?
Yes No
If yes, did you pass all of your courses for the most recent part-time study period for which you received a grant and/or a loan?
Yes No
If yes, please attach a transcript of your marks for that study period
If no, since the last time you received funding for part-time studies, have you funded one semester through your own resources and passed all of your courses for
that semester?
Yes No
o If yes, please attach a transcript of your marks for that semester.
B. Income Information (List the income from Line 15000 of your 2020 Income Tax Return)
Your Income
Your resources will be determined based on Line 15000 of your 2020 Income Tax Return. If you had no income, you
must submit documentation explaining this situation. Please note that if you are applying in the province or territory
of SK, MB, NS, NL, PEI, NB or YT you must submit a copy of your Notice of Assessment for verification.
Total Income $
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Your Spouse's/Common-Law Partner's Income
Your spouse's/common-law partner's resources will be determined based on Line 15000 of
their 2020 Income Tax Return. If they have no income, they must submit documentation
explaining this situation. Please note that if you are applying in the province or territory
of SK, MB, NS, NL, PEI, NB or YT, you must submit a copy of your spouse's/common-
law partner's Notice of Assessment for verification.
Spouse's/Common-Law Partner's
Social Insurance Number (SIN)
Total Income $
Total combined (Your and Your Spouse's/Common-Law Partner's) family 2020 Income
$
C. Applicant's Declaration and Signature
Have you received a Part-Time Canada Student Loan that you have
not fully repaid?
Yes No
If yes, what is the total outstanding balance to be
repaid on your part-time loan(s)?
$
I request financial assistance to undertake my part-time post-secondary studies in the amount of
$
Borrowers in default of their full-time or part-time student loans, or their Canada Apprentice Loans, are restricted from receiving all forms of further assistance until their
loans are brought up to date.
I will use this assistance to pay the costs associated with my program of studies. I authorize the government, appropriate authority, and educational institution to collect, use and
disclose data and information on verifying any information related to any loan and/or grant that I may have for the purpose of carrying out their duties under the administration and
enforcement of the Canada Student Financial Assistance Act and the Apprentice Loans Act. I authorize the Canada Revenue Agency to disclose any information pertaining to my
income tax records. I certify that I am not currently in default of any Canada Student Loans and/or Canada Apprentice Loan. I have given complete and true information on this form
and I understand that failure to do so may prevent my qualifying for assistance in the future. I understand that if I should receive a grant, it is awarded to me on the condition that it will
be used for the purposes for which it was intended. I understand that if I do not respect this condition, it may result in loss of eligibility for future grant funding and possible legal action
by the Government of Canada. I understand that, in respect of a Canada Student Loan and/or Grant if I knowingly make a false statement or misrepresentation in the
application or other document or wilfully provide any false or misleading information, I am guilty of an offence under the Canada Student Loans Act and/or Canada
Student Financial Assistance Act and liable for a fine or summary conviction.
Signature of Applicant Date (YYYY-MM-DD)
Spouse's/Common-Law Partner's Declaration and Signature
I have given complete and true information on this form. I understand that personal information that is relevant to a reassessment or an appeal may be shown to the applicant if the
applicant appeals his or her assessment or if the appropriate authority makes a reassessment of financial assistance. I authorize the Canada Revenue Agency to disclose any
information pertaining to my income tax records. I am not liable for loans given to the applicant.
Given and Family Name of Spouse/Common-Law Partner (please print) Signature of Spouse/Common-Law Partner
Date (YYYY-MM-DD)
D. Program Information
What is the name of the post-secondary institution you plan to attend?
What campus, college or city of this institution will you be attending?
What is your program of study?
I hereby request financial assistance for the following course(s):
Course Description Course Code
Type of Instruction
(e.g.: in-class/correspondence/tele-course/distance learning)
Start Date End Date
Example: Literature and Composition ENGL 100 Correspondence course (YYYY-MM-DD) (YYYY-MM-DD)
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E. To Be Completed By The Educational Institution
Complete Section E and verify that all information provided in Section D is complete and correct.
Period of Study
Commencement Date
(YYYY-MM-DD)
Period of Study
End Date
(YYYY-MM-DD)
What are the applicant's tuition and compulsory fees
(do not include residence fees) for the period of study?
$
What are the applicant's book and equipment costs for the
period of study?
$
What is the applicant's
percentage of a full
course load?
%
Number of Weeks of Study Number of Courses per Week
What is the level of the applicant's program?
Diploma Bachelor's Degree Doctoral Degree
Certificate Master's Degree
What faculty / division is the program considered to be in?
Administration / Business Community Service Health Sciences Theology Education
Agriculture / Related Sciences Dentistry Law Trades
Arts / Sciences Engineering / Technology Medicine Other (specify)
Program of Study
I certify that the above information in Section E of this application is correct based on the information provided by the applicant in Section D.
Name of Authorized Officer of the Educational Institution Title Telephone Number
Signature of Authorized Officer
Date (YYYY-MM-DD)
Address of Educational Institution
Educational Institution Code
F. To Be Completed By The Provincial/Territorial Ministry
Assessed and qualified for assistance
Yes No
Type of assistance to be provided
Canada Student
Grant
Part-Time Canada
Student Loan
Both
Field of study code
Family Size Including Applicant
Did the applicant successfully complete
previously funded courses (loan funding)?
Yes No
Did the applicant successfully complete
previously funded courses (grant funding)?
Yes No
Total Income
$
Tuition and Compulsory Fees
$
Books / Equipment
$
Transportation
$
Child Care
$
Miscellaneous
$
Total Expenses
$
Requested amount of assistance by applicant
(if indicated)
$
Total Assistance Authorized
Part-Time Canada Student Loan
$
Grant for Students with Permanent Disabilities
$
Grant for Part-Time Students with Dependants
$
Grant for Part-Time Studies
$
Part-Time Provincial Student Loan
$
Provincial Grant
$
Comments
Email Address of Educational Institution
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Part-Time Canada Student Loan
and Grant Application
Provincial/Territorial Student Aid Offices
Note:
* The province of Quebec, the Northwest Territories and Nunavut have chosen not to issue loans
or grants under the Canada Student Financial Assistance Program. If you reside in these areas,
please contact the appropriate office listed above for information on student assistance.
** The provinces of Alberta, British Columbia, and Ontario use a different application form for part-
time assistance. If you are a resident in one of these provinces, you should contact your
provincial student aid office as listed above or review their website for information on the
application process.
NEWFOUNDLAND & LABRADOR
Student Financial Services Division
Department of Education
PO Box 8700
St. John's NL A1B 4J6
Tel.: (709) 729-5849
Fax: (709) 729-2298
www.gov.nl.ca/studentaid
PRINCE EDWARD ISLAND
Student Financial Services
176 Great George Street
PO Box 2000
Charlottetown PE C1A 7N8
Tel.: (902) 368-4640
Fax: (902) 368-6144
www.studentloan.pe.ca
NOVA SCOTIA
Student Assistance Office
Department of Labour and Advanced
Education
1256 Barrington Street
PO BOX 2290
Halifax, NS B3J 3C8
Tel.: (902) 424-8420
Fax: (902) 424-0540
www.novascotia.ca/studentassistance/
NEW BRUNSWICK
Student Financial Services
Department of Post-Secondary Education,
Training and Labour
Beaverbrook Building
P.O. Box 6000,
Fredericton, NB E3B 5H1
Tel.: (506) 453-2577
1-800-667-5626
Fax: (506) 444-4333
www.studentaid.gnb.ca
MANITOBA
Manitoba Student Aid
401-1181 Portage Avenue
Winnipeg MB R3G 0T3
Tel.: 204-945-6321
Fax: 204-948-3421
www.manitobastudentaid.ca
SASKATCHEWAN
Student Service Centre
Ministry of Advanced Education
1120 - 2010 12th Avenue
Regina SK S4P 0M3
Tel.: (306) 787-5620
Toll Free: 1-800-597-8278
Fax: (306) 787-1608
www.saskatchewan.ca/studentloans
*QUÉBEC
Service de l'accueil et des renseignements
Aide financière aux études
1035, rue De la Chevrotière
Québec, QC G1R 5A5
Région de Québec : (418) 643-3750
Région de Montréal : (514) 864-3557
Sans frais au Canada et aux États-Unis : 1-877-643-3750
www.afe.gouv.qc.ca
**ONTARIO
Student Financial Assistance Branch
Ministry of Colleges and Universities
Ontario Student Assistance Program
(OSAP)
PO Box 4500
189 Red River Road 4th Floor
Thunder Bay, ON P7B 6G9
Tel.: (807) 343-7260
Toll-Free in North America: 1-877 OSAP -
411 (1 877 672 7411)
Telephone Device for the Deaf (TDD):
1-800-465-3958
Fax: (807) 343-7278
www.ontario.ca/osap
*NORTHWEST TERRITORIES
Student Financial Assistance
Department of Education, Culture and
Employment
Box 1320
Yellowknife NT X1A 2L9
Tel.: (867) 767-9355
1-800-661-0793
Fax: (867) 873 -0336
1-800-661-0893
www.nwtsfa.gov.nt.ca
**ALBERTA
Student Aid Alberta
PO Box 28000 STN MAIN
Edmonton AB T5J 4R4
Toll Free: 1 855-606-2096
studentaid.alberta.ca
YUKON TERRITORY
Student Financial Assistance
Department of Education
Government of Yukon
Box 2703
Whitehorse YT Y1A 2C6
Tel.: (867) 667-5929
Fax: (867) 667-8555
www.yukonstudentaid.com
**BRITISH COLUMBIA
Ministry of Advanced
Education and Skills Training
StudentAid BC
PO Box 9173
Stn Prov Govt
Victoria, BC V8W 9H7
Telephone:(toll free from Canada &
USA) 1-800-561-1818
Telephone: (from outside North America)
250-387-6100
Fax: (toll free) 1-866-312-3322
Fax: 250 356-9455
www.studentaidbc.ca
*NUNAVUT
Financial Assistance for Nunavut
Students
Department of Education
Toll Free: 1-877-860-0680 (Can also be
used locally)
Baffin: Tel.: (867) 473-2600
Toll Free: 1-800-567-1514
Kivalliq: Tel.: (867) 645-5040
Toll Free: 1-800-953-8516
Kitikmeot: Tel.: (867) 983-4031
Toll Free: 1-800-661-0845
www.gov.nu.ca/education
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APPLICANT - DETACH THIS PAGE AND RETAIN FOR YOUR RECORDS
Application for Assistance for Part-Time Studies
The Canada Student Loans Act and Regulations (CSLA) and / or the Canada Student Financial Assistance Act and Regulations (CSFAA) set forth the legal rights
and obligations of a student and should be referred to in the case of uncertainty or dispute. With respect to the assistance available to Part-Time students through
the Canada Student Financial Assistance Program (CSFA Program), the following definitions apply:
Canada Student Loan (CSL) - the repayable financial assistance to help eligible students pay for post-secondary education at a designated college,
university, or other post-secondary institution, according to the Canada Student Financial Assistance Regulation.
Canada Student Grant (CSG) - financial assistance awarded to qualifying students for the specific purpose of paying eligible costs associated with the
undertaking of a program of studies, as set out by the CSFA Program.
- Grant amounts are non-repayable provided that the eligibility criteria is maintained for the duration of the study period
for which the grant was awarded.
This application form will be used to assess your eligibility for Part-Time CSL assistance as well as CSG assistance for Part-Time Studies.
Incomplete applications cannot be processed. Please ensure that all requested information is provided. You must have a valid Social Insurance
Number (SIN) to apply. Print clearly and sign the application in ink.
Instructions To The Applicant
- To apply for Part-Time assistance, fully complete sections A, B, C and D of the attached application form.
- Have the Educational Institution where you are pursuing your Part-Time studies complete Section E.
- Submit the completed application form to the appropriate authority in the province in which you last resided for at least 12 months in a row (not including time
spent as a full-time post-secondary student). If you are applying in the province or territory of SK, MB, NS, NL, PEI, NB or YT, you must submit a copy of your
Notice of Assessment (and a copy of your spouse's or common-law partner's Notice of Assessment, if applicable). See list of Appropriate Authorities on Page 4
of the application.
Residency definition: The province or territory of residence of a part-time student is where they have last lived for at least 12 months in a row, not
including time as a full-time post-secondary student (but including time as a part-time post-secondary student).
Note: If you are a previous recipient of a grant and/or loan for Part-Time Studies, you must also provide documentation indicating successful
completion of all previously funded course(s).
Note to Applicants with Permanent Disabilities
The CSFA Program provides for the option of being considered Full-Time or Part-Time for students with permanent disabilities taking between 40% and 59% of a
Full-Time course load and additional assistance for students with permanent disabilities who demonstrate that they have a permanent disability which restricts
their ability to participate in post-secondary studies.
If you are an applicant with a permanent disability and you require additional funding to offset exceptional, education-related costs related to your permanent
disability, you may wish to contact your provincial student aid office and / or financial aid office at your Educational Institution and apply for the Canada Student
Grant for Services and Equipment for Persons with Permanent Disabilities (CSG-PDSE). Students who wish to apply for this grant, provided through the CSFA
Program, must fill out an additional application.
Privacy Notice Statement
The information you provide is collected under the authority of the Department of Employment and Social Development Act, the Canada Student Financial
Assistance Act (CSFAA) and Regulations, the Canada Student Loans Act (CSLA) and Regulations, and the Apprentice Loans Act (ALA) and Regulations for the
administration of the Canada Student Financial Assistance Program (CSFA Program) and/or the Canada Apprentice Loan (CAL). The Social Insurance Number
(SIN) is collected under the authority of the CSFAA, the Canada Student Financial Assistance Regulations (CSFAR), the Canada Student Loan Regulations
(CSLR), and the Apprentice Loans Regulations (ALR), and in accordance with the Treasury Board Secretariat Directive on the Social Insurance Number which
lists the CSFAA, the CSFAR, the CSLR, and the ALR as authorized users of the SIN. The SIN will be used as a file identifier and, along with the other information
you provide, will also be used to validate your application, and to administer and enforce the CSFA Program and the CAL.
Participation in the Canada Student Financial Assistance Program is voluntary. Refusal to provide personal information will result in not being considered for a
Canada Student Loan.
The information you provide may be disclosed to Statistics Canada for statistical and research purposes, the provincial/territorial government(s), the National
Student Loans Service Centre, the Canada Apprentice Loan Service Centre, financial institutions, the Canada Revenue Agency, consumer credit grantor(s), credit
bureau(s), credit reporting agency(ies), any person or business with whom you have or may have had financial dealings, and your Financial Institution(s) to
directly or indirectly collect, retain, use, and exchange among themselves any personal information related to this application for the purposes of carrying out their
duties under the Federal Act(s) and Regulation(s) and/or the applicable Provincial Act(s) and Regulation(s) relating to student and/or apprentice financial
assistance, including for administration, enforcement, debt collection, audit, verification, research, and evaluation purposes.
Your personal information is administered in accordance with the CSFAA and CSFAR, the CSLA and CSLR, the ALA and ALR, the Department of Employment
and Social Development Act, the Privacy Act, and other applicable laws. You have the right to the protection of, access to, and correction of your personal
information which is described in Personal Information Banks ESDC PPU 030 and/or ESDC PPU 709. Instructions for obtaining this information are outlined in the
government publication entitled, Info Source, which is available at the following web site address: www.canada.ca/infosource-ESDC. Info Source may also be
accessed on-line at any Service Canada Centre. You have the right to file a complaint with the Privacy Commissioner of Canada regarding the institution’s
handling of your personal information at:
https://www.priv.gc.ca/en/
CONTINUED
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Terms and Conditions
1. Eligibility for Program Assistance
The Canada Student Financial Assistance Program (CSFA Program) provides assistance for individuals who undertake their program of study on a Part-Time
basis. In order to be eligible you must:
- be a resident during your period of study of a province or a territory that issues CSLs;
- demonstrate financial need;
- be enrolled in 20-59% of a full course load at a designated Educational Institution;
- pass a credit check if you are 22 years of age or older and applying for a CSL for the first time;
- have not reached the maximum $10,000 in Part-Time CSL; and
- be a Canadian citizen, a permanent resident of Canada, a protected person (as defined by the Immigration and Refugee Protection Act), or a Person
registered as an Indian under the Indian Act;
- not be in default of a full-time or part-time CSL and / or a CAL.
Note: If you are in default on Part-Time and / or Full-Time CSLs issued prior to August 1, 2000, contact your lender to inquire what process is required to
remove the restricted status on your loan(s). If you are in default on previous loans issued after August 1, 2000, you will not be eligible for further
assistance until you receive clearance from the CSFA Program. Please contact the National Student Loans Service Centre (NSLSC) at
1-888-815-4514. If you are in default on your Canada Apprentice Loan, you are not eligible to receive further student financial assistance until your
restriction is removed. Please contact the Canada Apprentice Loan Service Centre at 1-855-844-5670 to inquire what process is required to remove
the restricted status on your loan.
2. Eligible Costs - Applications will be assessed based on the following costs (if applicable):
- tuition including compulsory fees;
- books and supplies;
- transportation to and from classes;
- child care costs incurred to attend classes; and
- an incidental allowance of $10 per week, per course.
Applicants taking studies through correspondence or distance learning may not be assessed child care and transportation costs,
except for those periods where in-class attendance is mandatory (e.g., examinations, etc.).
3. Resources
An applicant (and spouse or common-law, if applicable) is required to report all family income as per Line 15000 of their 2020 Income Tax Return(s). The
combined total family income (income before deductions) will determine eligibility for CSLs and CSGs.
4. Assistance Provided
Eligible applicants under the CSFA Program will be given assistance in the amount requested if the request is not more than the assessed need or the
maximum amounts allowable.
5. Repayment
The principal amount of a student loan made to the borrower as a part-time student, and any interest, commence to be payable by the borrower on the last
day of the seventh (7th) month following the month in which the applicant ceases to be a Part-Time Student. Interest does not accrue during the study
period on Part-Time loans and during the six months following the month you cease to be a student.
6. Verification
An applicant (and spouse or common-law) must sign a declaration releasing income tax data for verification.
An applicant (and spouse or common-law) must sign a certification on the application form that the information given is true and he / she is aware of the
terms and conditions and will abide by them.
Every person who, in respect of a student loan or other financial assistance to a student, knowingly makes any false statement or
misrepresentation, including by omission, in an application or other document or knowingly provides any false or misleading
information, including by omission, is guilty of an offence and liable on summary conviction to a fine not exceeding $1,000.
Details of your educational program and costs must be completed and signed by an official of your Educational Institution.
If you have previously received Part-Time CSLs, you must fully answer any questions concerning them.
Canada Student Grants
Grant for Students with Permanent Disabilities
Part-Time Students with permanent disabilities may be eligible to receive $4,000 per federal student loan year to help cover the costs of tuition,
books and accommodations.
Grant for Services and Equipment for Students with Permanent Disabilities
Part-Time Students with permanent disabilities may be eligible to receive up to $20,000 to help offset exceptional, education-related costs.
Applicants must complete a separate application form to apply for this grant.
Grant for Part-Time Students with Dependants
Part-Time Students with up to two dependants under 12 years of age (or older if the dependant has a permanent disability) may be eligible to
receive $80 per week of study up to a maximum of $3,840. Students with three or more dependants may be eligible to receive $120 per week of
study up to a maximum of $3,840.
Grant for Part-Time Studies
Part-Time Students may be eligible to receive up to $3,600 per student loan year.
For more information visit:
https://www.canada.ca/en/services/jobs/education/student-financial-aid.html