STUDENT LOAN APPLICATION FORM 2011
A) PERSONAL DATA
Surname: _________________________________ Date of Birth: ____________________
Given Name(s): _________________________________ Gender: ____________________
Social Insurance Number: ____________________ Citizenship: ____________________
Address: ________________________________________________________________________
_________________________________ email: ___________________________
Postal Code: _________________________________ Telephone: ____________________
Marital Status: _________________________________ Spouse's Name: __________________
Next of Kin (other than Spouse):___________________________________________________________
Address & Telephone: ___________________________________________________________
___________________________________________________________
B) EDUCATION AND EMPLOYMENT HISTORY:
Secondary School Attended: ___________________________________________________________
Highest Grade Completed & Date: _____________________________________________________
Post-Secondary Institution Attended:
Name Location Field of Study Dates
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
Employment History:
Employer Name Location Type of Work Dates
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
__________________ __________________ __________________ __________________
C) CURRENT OR PROPOSED STUDIES
Name of Institution & Location: _________________________________________________________
Faculty & Program Name: _________________________________________________________
Year of Enrollment: (in September):___________ Expected date of graduation: __________________
List of Scholarships/Bursaries/Loans and other Financial assistance. Please indicate if application is in process
OR if you have already received assistance (with Dates):
__________________________________________________________________________________
__________________________________________________________________________________
D) FINANCIAL DATA
Gross Income Last Year (from summer/work term): ____________________________________
Other Income (including student award, investment income, etc.): ___________________________
___________________________________________________________________________
Assets: Real Estate: _____________ Investment: _______________ Cash: _______________
Type of Accommodation during school year: ___________________________________________
E) INFORMATION ABOUT APPLICANT'S SPOUSE AND DEPENDENTS
Spouse's Social Insurance No: ________________________________________________________
Spouse's Income (Last Year): _________________ Occupation: ________________________
Spouse's Assets: Real Estate: ____________ Investment: ____________ Cash: _____________
Total Number of Children: ____________ Number of Children 12 & under: _________________
Declaration (to be signed by spouse):
I declare that all information above is true and complete in all respects.
Signature: ________________________
F) INFORMATION ABOUT APPLICANT'S PARENTS OR OFFICIAL SPONSOR AND
SPONSOR'S SPOUSE
Name(s): ______________________________________________________________________
Relationship to Applicant: _________________________________________________________
List of Children/Dependent during study period applied for:
1. __________________________________ Age: ________ Grade: ___________
2. __________________________________ Age: ________ Grade: ___________
3. __________________________________ Age: ________ Grade: ___________
4. __________________________________ Age: ________ Grade: ___________
Financial Data: Parent / Sponsor Other Parent / Sponsor's Spouse
Name: _______________________ ________________________________
Employment: _______________________ ________________________________
Gross Income (Last Year) _____________________ ________________________________
Assets: Real Estate: _______________________ ________________________________
Investment: _______________________ ________________________________
Cash: _______________________ ________________________________
Declaration (to be signed by Applicant's parents or sponsor & sponsor's spouse):
I / We declare that the information given above is true and complete in all respects.
Signature: 1. ______________________ 2. _______________________
G) APPLICANT'S DECLARATION
I declare that the information given above is true and complete in all respects.
Signature: _________________________ Date: ___________________