BURSARY APPLICATIONDate:

School of Architecture bursary awards are meant to help students overcome temporary financial emergencies such as medical costs or other unforeseen expenses. As funds are extremely limited, exaggeration of your own needs or misrepresentation of your assets may result in unfortunate consequences, such as withdrawal for other needy students.

IMPORTANT GUIDELINES

All sections of the application must be completed. Incomplete applications will not be considered.

You must be registered for courses in the current term to be eligible to receive a bursary.

If you are eligible to apply for a Canada Student Loan and Provincial Student Loan, you must have applied already. A copy of your student aid assessment sheet(s) must be attached to this bursary application. If you applied but were not awarded a Canada or Provincial student loan, please enclose a copy of the non-eligibility letter from the government. If you have not applied for a student loan, include an explanation.

Bursary decisions take approximately two weeks. A message will be sent to all students, indicating the outcome of their bursary application.

Bursary decisions cannot be appealed.

PERSONAL IDENTIFICATION
Family Name: / Given Name:
Student Number: / Program:
School: / Architecture / Year of Study: / 3 / 4 / 5 / 6
SIN: / - - / Gender: / Male / Female
Local Mailing Address: / Postal Code:
Telephone: / Dal E-Mail:
Citizenship Status: / Canadian / Permanent Resident / Student Visa
Country of Birth:
Marital Status: / Single / Married / Common Law / Divorced / Separated
No. of dependents currently living with you:
Previous Bursaries Received From Dalhousie University
Academic Year / Amount / Source
$
$
$
SECTION 1
Student Aid Assessment for the given current academic year
(Please include a photocopy of your Student Aid Assessment Sheets.)
Do you have a… / Amount / Copy of Assessment Sheet Attached?
Canada Student Loan? / Yes / No / $
Provincial Student Loan? / Yes / No / $
Provincial Student Bursary? / Yes / No / $
Bank/Student Education Loan? / Yes / No / $
SECTION 2
Applicant & Spouse Debt Structure
Accumulated student loans, including this academic year: / $
Accumulated debts from banks, trust or finance companies: / $
Accumulated balance on credit cards (e.g. Visa, MasterCard): / $
Private Loans: / $
TOTAL: / $
SECTION 3
Use of a Motor Vehicle
Are you (or your spouse) the legal operator and or owner of a motor vehicle (including motorcycle)? / Yes / No
If yes, how many kilometres do you live from campus?: / km
Monthly payments (if applicable): / $
Monthly maintenance on vehicle: / $
Monthly amount spent on fuel: / $
Monthly amount of insurance payment: / $
TOTAL = / $ / x 12 = / $
SECTION 4
BUDGET FOR THE CURRENT FOUR-MONTH TERM.
(You must disclose details of all expenses and resources in order to be considered for a bursary.)
EXPENSES (include all expenses for 4 months)
a)Tuition & prescribed fees: / Applicant- / $ / Spouse- / $ / = / $
b)Differential fee
(International students only, if applicable): / Applicant- / $ / Spouse- / $ / = / $
c)Books & supplies: / Applicant- / $ / Spouse- / $ / = / $
d)Instruments, equipment, special clothes: / Applicant- / $ / Spouse- / $ / = / $
Provide details:
e)Lodging: / Residence: / Rent/Month- / $ / x / 4 Months- / = / $
(average over / Off-Campus: / Rent/Month- / $ / x / 4 Months- / = / $
4 months) / Room & Board: / Rent/Month- / $ / x / 4 Months- / = / $
f)Groceries: / Cost/Month- / $ / x / 4 Months- / = / $
g)Telephone: / Cost/Month- / $ / x / 4 Months- / = / $
h)Electricity: / Cost/Month- / $ / x / 4 Months- / = / $
i)Heat & Water: / Cost/Month- / $ / x / 4 Months- / = / $
j)Child Care: / Cost/Month- / $ / x / 4 Months- / = / $
k)Miscellaneous Expenses:
(Provide detailed explanation) / = / $
= / $
= / $
l)Use of a Motor Vehicle Total (from Section 3): / = / $
TOTAL EXPENSES / $
RESOURCES (include all resources for 4 months)
a)Canada Student Loan (from Section 1): / Applicant- / $ / Spouse- / $ / = / $
b)Provincial Student Loan (from Section 1): / Applicant- / $ / Spouse- / $ / = / $
c)Provincial Bursary (from Section 1): / Applicant- / $ / Spouse- / $ / = / $
d)Bank Student/Education Loan (from Section 1): / Applicant- / $ / Spouse- / $ / = / $
e)Non-Dalhousie Bursaries, Scholarships, Awards, External Funding, etc.: / Applicant- / $ / Spouse- / $ / = / $
f)Income Over 4 Months (including Teaching Assistantships & Research Grant Funding):
Applicant: / Source- / Amount /Month- / $ / x / # of Months- / = / $
Applicant: / Source- / Amount /Month- / $ / x / # of Months- / = / $
Applicant: / Source- / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Source- / Amount /Month- / $ / x / # of Months- / = / $
g)Maintenance: / Amount /Month- / $ / x / # of Months- / = / $
h)Family Allowance: / Amount /Month- / $ / x / # of Months- / = / $
i)CCRA Rebate: / Applicant- / $ / Spouse- / $ / = / $
j)Social Services: / Applicant: / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Amount /Month- / $ / x / # of Months- / = / $
k)Department of Veteran Affairs (DVA) Allowance: / Applicant: / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Amount /Month- / $ / x / # of Months- / = / $
l)Canada Pension: / Applicant: / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Amount /Month- / $ / x / # of Months- / = / $
m)Adult Training: / Applicant: / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Amount /Month- / $ / x / # of Months- / = / $
n)Employment Insurance (EI): / Applicant: / Amount /Month- / $ / x / # of Months- / = / $
Spouse: / Amount /Month- / $ / x / # of Months- / = / $
All Other Resources: (Provide detailed Explanation)
Applicant- / $ / Spouse- / $ / = / $
Applicant- / $ / Spouse- / $ / = / $
TOTAL RESOURCES / $
NEED (TOTAL EXPENSES MINUS TOTAL RESOURCES) / $
SECTION 5
Explanation of Need
Note: this section MUST be completed in order for the application to be considered.
SECTION 6

Applicant's Declaration and Authorization

I declare that the foregoing information is, to my knowledge, a true, complete, and accurate statement of my financial status, and I hereby request consideration for assistance from the funds made available for this purpose by the University.

I authorize Dalhousie University to release bursary award information to the federal or provincial student financial aid office.

I also authorize the University to contact my sources of funds/expenses, if this is judged to be necessary.

I understand that, if awarded, any monies owing to the university will be deducted from the bursary.

Name of Applicant / Signature / Date
Submit to: / School of Architecture office
5410 Spring Garden Road
P.O. Box 15000
Halifax, NS B3H 4R2
902-494-3971

Revised November 2011 School of Architecture Bursary Application, based on Faculty of Graduate Studies Bursary ApplicationPage 1