Fill - Free fillable PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022 (Government of Nova Scotia) PDF form

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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 $

ESDC SDE0031 (2021-06-FINAL) E

Page 2 of 6

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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)

ESDC SDE0031 (2021-06-FINAL) E

Page 3 of 6

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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

ESDC SDE0031 (2021-06-FINAL) E

Page 4 of 6

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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

ESDC SDE0031 (2021-06-FINAL) E

Page 5 of 6

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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

ESDC SDE0031 (2021-06-FINAL) E

Page 6 of 6

PROTECTED B WHEN COMPLETED

IMPORTANT - PLEASE READ THIS APPLICATION IN ITS ENTIRETY

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

Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022 (Government of Nova Scotia)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022 (Government of Nova Scotia) Form

Related forms

Fillable PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022 (Government of Nova Scotia)

Fill Online, Printable, Fillable, Blank PART-TIME STUDENT GRANT AND LOAN APPLICATION 2021-2022 (Government of Nova Scotia) Form

Related forms

First 20 documents completely FREE!