Fillable Page A Part-time student aid is intended to (Alberta Student Aid)

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Page A Part-time student aid is intended to (Alberta Student Aid)

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Application For Financial Assistance Part-Time Last revised June 2020 Page A
Information for Part-Time Post-Secondary Students
Page A
Eligibility Requirements for Part-Time Loans and Grants:
• You must be a resident of Alberta. This means that:
- Alberta is the last province you have lived in for 12
consecutive months without being a full-time post-
secondary student, or
- You are living in Alberta and have never lived in any
Canadian province for 12 months in a row. In this case,
submit a Residency Resumé (studentaid.alberta.ca)
and/or a letter to explain your residency situation.
• You must demonstrate nancial need.
• Eligibility for student aid is determined by using an income
threshold table based on line 15000 of you and your spouse’s/
partner’s (if applicable) income tax return or the Expected
Reduced Yearly Income. Your family income must be less
than the amounts listed in the charts on Pages B and C.
• Any federal or provincial loans you have must be in
good standing.
• If you are in default on your Canada Apprentice Loan, you are
not eligible to receive further student nancial assistance until
your restriction is removed.
• Courses must be part of an approved program of study
and taken for credit.
Tips to Complete Your Application
• All $ amounts must be submitted in Canadian dollars.
• Apply at least 4–6 weeks before your course(s) start.
• Ensure Alberta Student Aid receives this application at least
30 days before this application’s period of study end date.
• Part-time student aid is intended to help cover the cost
of tuition, books, travel, and daycare (if applicable).
• If you have received previous part-time student aid, you must
successfully complete all previously funded courses to receive
student aid on a subsequent application.
• Section 5 of this application must be completed and signed
by your educational institution.
Important: Pages A, B, and C provide information about funding for part-time students. Do not include with your application.
You may be asked to provide your Social Insurance Number, Alberta Student Number (ASN), and/or School Identication Number.
Please have these numbers available for reference.
If you do not know your ASN, or do not have an ASN, go to: learnerregistry.ae.alberta.ca
You can also call toll-free in Alberta at 310-0000 to have a Request for Alberta Student Number form mailed to you. Due to privacy
issues, ASN’s will not be given over the telephone.
For further assistance:
• Contact the Financial Aid Ofce at the school you plan to attend
• studentaid.alberta.ca
For All Student Aid Inquiries Call the Alberta Student Aid Service Centre:
• 1 855-606-2096 (toll free from anywhere in North America)
• 1 855-306-2240 (TTY for the hearing impaired)
• 800 2 529-9242 (outside North America – add the appropriate international access code)
Gender: Choose X if you do not identify as male
or female, or choose to self-identify as X.
Send documents electronically
1. Visit studentaid.alberta.ca
2. Sign in to your account
3. Submit securely using Upload Electronic Document(s)
For assistance: eDoc Upload FAQs
Mailing Address
ALBERTA STUDENT AID
PO BOX 28000 STN MAIN
EDMONTON AB T5J 4R4
Upload or Mail Your Form
Application For Financial Assistance Part-Time Last revised June 2020 Page B
Page B
Alberta Part-Time Grant*
*You must be attending an educational institution in Alberta.
Canada Student Grant for Part-Time Studies
Note: A student cannot receive the Alberta Part-Time Grant and the Canada Student Grant for Part-Time Studies for the same study period.
• Students attending a post-secondary institution may be eligible for up to $600 per semester.
• The maximum grant funding available for one calendar year is $1,800.
• To be eligible, family income (Line 15000 of 2019 income tax form(s)) must be equal to or below the Income Threshold in the chart
below.
Additional Eligibility Criteria to receive up to a maximum of $3,600 annually in grant funding
• The student must be enrolled in 20-59% of a full-time course load.
• The amount of the grant is based on family income (Line 15000 of 2019 income tax form(s) or Expected Reduced Yearly Income)
and family size.
• To be eligible for the maximum grant amount, family income must be equal to or below the amount in column (A).
• The amount of the grant gradually decreases as income increases, with the rate of reduction varying by family size. Eligibility for the
grant is cut-off when family income is equal to or greater than the amount in column (B).
Family Size 1 2 3 4 5 6 7 or more
Income Threshold $48,547 $67,966 $81,464 $91,032 $98,465 $104,532 $109,663
Income Threshold Chart (CAD$)
Canada Student Grant for Part-time Studies
Family Size
(A) Family income* threshold to
receive maximum grant amount
(B) Family income* threshold at which
eligibility for the grant is cut-off
1 person $31,868 $63,381
2 persons $45,068 $88,673
3 persons $55,196 $105,872
4 persons $63,735 $116,552
5 persons $71,258 $126,405
6 persons $78,060 $135,752
7 persons or more $84,313 $143,837
* Family income from Line 15000 of 2019 income tax form(s) or from the Expected Reduced Yearly
Income field on the application.
In the Charts on Pages B and C
• Family size means you, your spouse/partner, and your dependent children (if applicable).
• If your family income last year was higher than the amounts listed in the charts but is now lower, you may provide an explanation
of your situation and documentation of your current income.
Important: Pages A, B, and C provide information about funding for part-time students. Do not include with your application.
Application For Financial Assistance Part-Time Last revised June 2020 Page C
Page C
Additional Eligibility Requirements for:
• Part-Time Canada Student Loan
- Your part-time Canada Student Loan balance cannot exceed $10,000 at any time.
- You must be enrolled in 20-59% of a full-time course load.
• Canada Student Grant for Students with Permanent Disabilities, and
Canada Student Grant for Services and Equipment for Students with Permanent Disabilities
- You must have part-time Canada Student Loan eligibility.
- You must be a person with a permanent disability as dened by the Canada Student Loan Program and provide acceptable
documentation.
- You must complete a Schedule 4 the rst time you are applying as a student with a documented permanent disability.
The Disability Advisor/Reviewer at the school may be authorized to sign Schedule 4.
- For the Services and Equipment grant, you must have a need for exceptional education-related services or equipment required
to participate in post-secondary studies.
To be eligible for the above loan or grants, family income (Line 15000 of 2019 income tax form(s) or Expected Reduced Yearly
Income) must be below the Income Threshold in the chart below.
Part-Time Canada Student Loan
Canada Student Grant for Students with Permanent Disabilities
Canada Student Grant for Services and Equipment for Students with Permanent Disabilities
Family Size 1 2 3 4 5 6 7 or more
Income Threshold $65,342 $91,387 $109,027 $119,839 $129,838 $139,343 $147,543
Canada Student Grant for Part-time Students with Dependants
Additional Eligibility Criteria to receive up to a maximum of $3,840 annually in grant funding
• The student must be enrolled in 20-59% of a full-time
course load.
• Students with 1 or 2 dependants may receive up to $80 per
week; students with 3 or more dependants may receive up
to $120 per week. The maximum grant amount is $3,840
regardless of family size.
• The grant is for students with dependent children between
0 to 11 years of age who are living with the student and for whom
the student and/or their spouse/partner are legally responsible.
• The grant is also available for students with dependent
children with a permanent disability between 12 to 18 years
of age, and individuals over 18 years of age with a permanent
disability who are wholly dependent on the student.
• The amount of the grant is based on family income (Line 15000
of 2019 income tax form(s) or Expected Reduced Yearly Income)
and family size.
• To be eligible for the maximum weekly grant amount, family
income must be equal to or below the amount in column (A).
• The weekly grant amount gradually decreases as income
increases, with the rate of reduction varying by family size.
Eligibility for the grant is cut-off when family income is equal
to or greater than the amount in column (B)
Income Threshold Chart (CAD$)
Canada Student Grant for Part-time Students with Dependants
Family Size
(A) Family income* threshold to
receive maximum grant amount
(B) Family income* threshold at which
eligibility for the grant is cut-off
2 persons $45,068 $88,673
3 persons $55,196 $105,872
4 persons $63,735 $116,552
5 persons $71,258 $126,405
6 persons $78,060 $135,752
7 persons or more $84,313 $143,837
* Family income from Line 15000 of 2019 income tax form(s) or from the Expected Reduced
Yearly Income field on the application.
Important: Pages A, B, and C provide information about funding for part-time students. Do not include with your application.
Maiden Name (if applicable)
Month Year
Date completed/last attended regular High School
(excludes upgrading)
Application For Financial Assistance Part-Time Last revised June 2020 Page 1
Social Insurance Number (SIN)
Gender
Male
Female
X (see Page A)
Birthdate
Day Month Year
The following question is optional. Your answer will not
affect your eligibility for funding. If you wish to declare your
Canadian Indigenous heritage as indicated under Section 35
of the Constitution Act, 1982, check the box that applies to you.
Advanced Education uses the information about Canadian First
Nations, Métis, and Inuit students to measure the effectiveness
of programs and to research ways to improve Indigenous student
success rates.
Status Indian/First Nations
Non-Status Indian/First Nations
Métis
Inuit
20/21 P
• Alberta Student Aid must receive this application at least 30 days before this application’s period of study end date.
• To complete a fillable form: 1. Save to your desktop. 2. Complete form. 3. Save nal. Check, then submit. Never complete in a browser.
Alberta Student Aid
Application for Financial Assistance For
Part-Time Post-Secondary Studies 2020/2021
(Taking less than 60% of a Full Course Load)
*Students who are Protected Persons, including
Convention Refugees, may be eligible for student aid.
You must submit:
• A copy of your Social Insurance Number card or letter
AND a copy of one of the following:
• Notice of Decision, or
• Verication of Status Document (VOS)
These documents must be valid at the start of your
current study period.
Section 1 - Personal Information
Have you lived in Alberta all your life?
Yes
No
If no, is Alberta the last province you have
lived in for 12 consecutive months without
being a full-time post-secondary student?
Yes
No
Marital Status: (check one)
(for definition of dependent children, see Section 3)
Single (no dependent children)
Single (with dependent children)
Separated/Divorced/Widowed (no dependent children)
Separated/Divorced/Widowed (with dependent children)
Married
Common Law
You are considered to have a common law partner if:
• you and an individual have lived together in a conjugal
relationship continuously for the past one year, or
• you have declared an individual to have a status
equivalent to that of your common law partner under
any law of Alberta or of Canada, or
• you and an individual are living together in a conjugal
relationship where there are one or more children of
the relationship by birth or adoption.
For Office Use Only App ID
Citizenship Status: (check one)
(Students with a study permit are not eligible for funding from
Alberta Student Aid)
Canadian
Permanent Resident
Protected Person* (see explanation on bottom right)
Last Name (current legal name)
First Name (current legal name)
If you have changed your name since you last applied,
provide legal documentation.
Apartment or Box Number
Street Address (add direction, e.g. S, NW, SE, if applicable)
City/Town
Mobile Number (format: 999-999-9999) to receive text messages
Telephone Number (format: 999-999-9999)
Email Address (mandatory)
Middle
Initial
Prov/State Country Postal/Zip Code
Alberta Student Number (mandatory)
(go to learnerregistry.ae.alberta.ca)
Section 4 - Income and Resource Information Before Starting School
To be completed by the applicant and the applicant's spouse/partner
Dependent children mean those children who are living with you and for whom you and/or your spouse/partner are legally
responsible.
Number of dependent children between 0 –11 years of age
Number of dependent children between 12–18 years of age
• How many of these dependant(s) have a permanent disability, aged 12 to 18*?
*Provide documentation of care required for your dependant with a permanent disability.
Number of individuals over 18 years of age who are wholly dependent
on you and/or your spouse/partner, as reported on your tax return(s)
• How many of the individuals over 18 years of age who are wholly dependent on you have a permanent disability?
*Provide documentation of care required for the individuals with a permanent disability.
How much is your monthly childcare cost (after subsidy) for those children
11 years old or younger, and/or children 12 – 18 who have a permanent disability?
$
Application For Financial Assistance Part-Time Last revised June 2020
Page 2
Alberta Student Aid will contact the person below to obtain your new address, telephone number or email address if unable to contact
you using the information you provided on page 1.
Section 3 - Dependants
Section 2 - Emergency Contact Information
Last Name
First Name
Apartment or Box Number
Middle
Initial
Street Address
City/Town
Prov/State Country Postal/Zip Code
Telephone Number (format: 999-999-9999)
Relationship to You
Applicant’s Total Income from Line 15000 of 2019 tax return
$
Applicant’s Expected Reduced Yearly Income
(If income in the current year is expected to be lower than Total Income from Line 15000 above.)
$
Spouse’s/Partner’s Total Income from Line 15000 of 2019 tax return
$
Spouse’s/Partner’s Expected Reduced Yearly Income
(If income in the current year is expected to be lower than Total Income from Line 15000 above.)
$
The amounts entered for Total Income and Expected Reduced Yearly Income by the Applicant and their Spouse/
Partner affects grant eligibility. If a change to these amounts is submitted after any portion of funding has been
paid, grant eligibility will not be reassessed.
Spouse’s/Partner’s Social Insurance Number
Date spouse/partner completed/last attended regular High School
Month Year
Has the Applicant's spouse/partner lived in Alberta all their life?
• If no, is Alberta the last province the Applicant's spouse/partner has
lived in for 12 consecutive months without being a full-time student?
Yes
No
Yes
No
Is the Applicant currently receiving Assured Income for the Severely
Handicapped (AISH) ?
Yes
No
Is the Applicant currently receiving Income Support?
Yes
No
No. of
Courses
*Tuition and/or Fees
*Book/Supply Costs
(Includes Rentals)
Course Name & Number Tuition and/or Fees Book/Supply Costs
Course Previously Taken
Part-Time (Y/N)
Application For Financial Assistance Part-Time Last revised June 2020
Section 5 - Students DO NOT complete Section 5. This section is completed by the Awards Officer or Registrar’s Office
or representative of your school.
Page 3
What is the student’s expected PERCENTAGE of a full course load? % (must be less than 60%)
Is the student enrolled in a correspondence/e-learning/distance study course(s)?
Yes
No
School Student ID Number
Alberta Student Number
Study Dates
Day Month Year
End (include nal exam dates)
Note: This application for student aid can cover part-time studies for up to 12 months, however, if the student is enrolled in more than
one course and there is a 30 day gap between courses, the student must apply for student aid on a separate application.
*Round to the nearest dollar
Program Information
List Course(s) for Current Study Period (mandatory) Only list courses for which the student will receive credit.
If more than four courses, attach the information separately.
Have any of the courses listed above been taken previously by the student?
Yes
No
Educational Institution Information
Name of School
Campus Name (if not attending main campus)
Program
Start
Day Month Year
Signature of School Ofcial Title of School Ofcial Today’s Date
Day Month Year
✗
SIGN HERE
Program Outcome
Certicate
Diploma
Degree
Degree – Master's
Degree – Doctoral
School Stamp
City/Town Prov/State Country
Printed Name of School Ofcial Direct Telephone Number (format: 999-999-9999)
Email Address of School Ofcial
Application For Financial Assistance Part-Time Last revised June 2020
Section 7 - Applicant Consent and Declaration
Section 6A - Requested Need - You can enter an amount below or, if you leave it blank, a calculation will be done
Section 6 - Additional Information Required
Page 4
Do you want to be considered for a Part-time Canada Student Loan?
Yes
No
Have you received a Part-time Canada Student Loan from a province other than Alberta?
Yes
No
I have defaulted on my previous Full-time or Part-time Canada Student Loan and/or Canada Apprentice Loan (CAL)
Yes
No
Not Applicable
• If yes, you are not eligible to receive further student aid until your loans are brought up to date.
Are you a student with a permanent disability?*
Yes
No
• *If yes, and you have previously provided documentation to conrm your permanent disability, you do not have to submit more
documents with this application.
• If yes, you may qualify for the Canada Student Grant for Students with Permanent Disabilities.
• If yes, and you require assistive services or equipment, you may qualify for the Canada Student Grant for Student Services and
Equipment for Students with Permanent Disabilities.
• To apply for either Canada student grant, you must complete a Schedule 4. For assistance or more information,
see the Disability Advisor/Reviewer at your school.
NOTE: This student aid is intended to help cover the
cost of tuition, books, travel and daycare (if applicable).
Applicant Consent and Declaration continues on Page 5
Signatures Required on Page 5
Total Part-time assistance requested $
Advanced Education is collecting this personal information under the authority of sections 33(a) and (c) of the Freedom of Information and
Protection of Privacy Act (Alberta) to determine and verify your 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.
I declare that:
• the information provided by me in this Application, and all
applicable schedules, is true and complete, including all nancial
information, and I understand that the information that I have
provided is subject to review and assessment by the Minister
of Advanced Education in accordance with the Student Financial
Assistance Act (Alberta), the Canada Student Loans Act and the
Canada Student Financial Assistance Act.
• I will use any nancial assistance awarded to me towards
the cost of my education.
• I have not applied to another province or territory for student
nancial assistance for the same period for which I am applying
for funding in this Application.
I agree to:
• provide information or documents as requested by Advanced
Education to verify any statements made in this Application.
• immediately notify Advanced Education in writing of any change
in my address, marital or common law partner status, nancial
circumstances, academic status or study period.
• repay my loan in full.
I understand that:
• I may be required to immediately repay any nancial assistance
I receive if there are any changes to my nancial circumstances,
marital or common law partner status, academic status or
study period.
• I may be denied nancial assistance if I fail to notify Advanced
Education in writing of any change in my nancial circumstances,
marital or common law partner status, academic status or study
period, or fail to provide documents or information as requested
by Advanced Education to verify statements made in this
Application.
• if I make a false or misleading statement in this Application,
or fail to disclose information as requested by Advanced
Education, I may be denied nancial assistance, and/or required
to immediately repay all nancial assistance received, and/or
subject to criminal prosecution.
• I am not entitled to apply for or receive nancial assistance from
another province or territory for the same period of time that I am
getting nancial assistance from Advanced Education.
• failure to disclose information or provide updated information
as requested by Advanced Education may constitute the making
of a false or misleading statement.
• Advanced Education has the right to recover benets I receive
which I am not entitled to, including any benets received due
to administrative errors.
Application For Financial Assistance Part-Time Last revised June 2020
Advanced Education is collecting this personal information under the authority of sections 33(a) and (c) of the Freedom of Information and
Protection of Privacy Act (Alberta) (“FOIP”) 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 FOIP.
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.
The personal information may be disclosed to:
• federal, provincial or territorial government departments or
agencies or educational institutions named in this Application, to
verify information the Applicant provided, determine the eligibility
of the Applicant for nancial assistance and to administer student
nancial assistance programs.
• the federal government for use in research, statistical analysis
and evaluations related to student nancial assistance programs.
• Alberta Community and Social Services and Alberta Labour
and Immigration to operate and administer nancial assistance
programs, including your eligibility, and the eligibility of the
Applicant, for nancial assistance.
• any lending institution or credit bureau to verify any information
the Applicant provided, to determine the eligibility of the Applicant
for nancial assistance and to administer student nancial
assistance programs.
• the Applicant for the purposes of determining and verifying
the Applicant’s eligibility for nancial assistance.
Page 5
If I receive financial assistance, I acknowledge the authority of,
and where a consent is required hereby irrevocably authorize the
Minister to disclose and exchange my personal information with:
• the Government of Canada, the National Student Loans Service
Centre, any provincial or territorial government department or
agency, any lending institution where I may have a student loan,
any educational institution or credit bureau for any purpose
related to the verication of information provided by me and
for administration and enforcement related to student nancial
assistance programs;
• Employment and Social Development Canada through the Social
Insurance Registry to verify my Social Insurance Number, name,
date of birth, and gender solely to conrm identication for the
purpose of nancial assistance;
• Alberta Community and Social Services and Alberta Labour
and Immigration to operate and administer nancial assistance
programs, including determining my eligibility, and the eligibility
of my spouse/partner, for nancial assistance;
• any of the following: lending institutions; credit bureaus; the
educational institution(s) named in the Application; and any
third party authorized to collect a debt owed to Her Majesty the
Queen in right of Alberta, in each case for any purpose relating
to administration, enforcement or collection related to student
nancial assistance programs;
• federal government departments or agencies or the educational
institution(s) named in the Application to conduct research,
statistical analysis, and evaluations related to student nancial
assistance programs.
I have read, understood, and agree to be bound by all of the consents and declarations contained within pages 4 and 5 of this Application.
Section 7 - Applicant Consent and Declaration - Continued from page 4
Section 8 - Spouse/Partner Declaration (if applicable)
Spouse/Partner Declaration
• I declare that my personal information included on this form is true and complete.
Applicant Signature (must be original, handwritten signature) Today’s Date
✗ DIGITAL or ELECTRONIC SIGNATURE NOT ACCEPTED
Day Month Year
Signature of Spouse/Partner (must be original, handwritten signature) Today’s Date
✗ DIGITAL or ELECTRONIC SIGNATURE NOT ACCEPTED
Day Month Year
Alberta Student Number (mandatory) (go to learnerregistry.ae.alberta.ca)
Send documents electronically
1. Visit studentaid.alberta.ca
2. Sign in to your account
3. Submit securely using Upload Electronic Document(s)
For assistance: eDoc Upload FAQs
Mailing Address
ALBERTA STUDENT AID
PO BOX 28000 STN MAIN
EDMONTON AB T5J 4R4
Upload or Mail Your Form
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