International Work Study Plan Application Form - Seneca College

You may attach your RESUME to this application.
PERSONAL INFORMATION:
International Work Study Plan Application Form
Last Name:
First Name:
Student Number:
Social Insurance Number:
Street Address:
Apt./Unit No.
City/Town: Province: Postal Code:
Home Telephone Number:
(Area Code)
Gender:
Male
Female
Citizenship Status:
Canadian Citizen
Permanent Resident/Protected Person
Do you have a Permanent Disability:
Yes
No
Campus: Percentage of a full course load: %
STUDENT DECLARATION:
I certify that the above information is true and correct and that I require additional assistance to complete my studies. My academic progress is satisfactory and
I agree to notify the Financial Aid Administrator, in writing, of any change in my academic, financial, family, or study-period status during the period covered by this
application. I authorize the employer to check the previous work references that I have provided.
Student Signature:
Date:
EMPLOYER INFORMATION:
Position Title: Salary charged to: / / 0 148
If for any reason, the student does not complete the full period of employment, I will notify the Financial Aid Administrator.
(PLEASE PRINT)
Name of Employer Signature of Employer Department and Extension Date
FOR FINANCIAL AID OFFICE USE ONLY:
Academic Year: Work-Study Period: Gross earnings not to exceed: $
Signature of Financial Aid Administrator:
The objective of the Work Study Plan (WSP) is to help students
with financial need meet their educational costs by working parttime
at the College during the study year and is administered
by designated staff in the Financial Aid Office. Your personal
information is collected on this form to determine your eligibility,
as well as your OSAP file if you are a recipient of this funding,
and for monitoring your academic progress while participating
in the WSP. Personal information on this form is collected
in accordance with sections 21, 39 and 49 of the Freedom of
Information and Protection of Privacy Act and under the legal
authority of the Ministry of Training, Colleges and Universities
Act, R.S.O. 1990, and the Ontario Colleges of Applied Arts and
Technology Act, 2002, Regulation 34/03, and may be used and/
or disclosed for administrative, statistical and/or research
purposes of the College and/or the ministries or agencies of
the Government of Ontario and the Government of Canada. If
you have any questions concerning the collection and use of
personal information, please contact the Privacy Office at (416)
491-5050 extension 77846 or email privacyoffice@senecacollege.
ca. The mailing address for the Privacy Office is 8 The Seneca
Way, 7th Floor, Markham, Ontario, L3R 5Y1.
OFFICE USE ONLY:
OSAP:
Yes
Date:
No
Semester Program Status Transcript
Comments:
Returning WSP Student?
Emailed Employer?
Date:
Yes
Yes
No
No
Page 1 of 2
TO BE DUPLICATED ONLY BY FINANCIAL AID AND AWARDS OFFICE.
Last Revised: October 24/12

STUDENT PERSONAL & FINANCIAL INFORMATION:
What year did you finish high school:
Do you live with your parents?
Yes
No
Marital Status:
Single Dependant: Less than 4 years out of high school (Complete SECTION A below)
Single Independant: More than 4 years out of high school (Complete SECTION B below)
Married/Common-law Divorced/Separated/Widowed Sole Support Parent
FINANCIAL INFORMATION:
Number of dependants in family still attending
school (including self) or who have a disability:
COMPLETE ONE SECTION ONLY.
SECTION A: -- OR --
SECTION B:
Number of dependants:
Ages:
Ages:
Number of above at post-secondary institutions (including self):
Level of Family Income: Father Mother
0 - $30,000
$30,000 - $50,000
Over $50,000
Level of Family Income: Self Spouse
0 - $30,000
$30,000 - $50,000
Over $50,000
a) Have you applied for OSAP this year? Yes: Amount of Loan $ No: Why?
b) Do you have a part-time or full-time job outside campus? Yes No: Why?
SCHOOL BUDGET:
BUDGET FOR SCHOOL PERIOD: Check off the semesters you are registered in for this academic year:
September to April (8 months)
September to December (4 months)
January to August (8 months)
January to April (4 months)
September to August (12 months)
May to August (4 months)
Expenses Amount Income/Resources Amount
Tuition Fees = $ Savings - from Pre-study/Work-term = $
Book & Supplies = $ Parental/Spousal Assistance = $
Rent $ x = $ Awards/Scholarships/Bursaries = $
Utilities $ x = $ OSAP/Government Student Loans = $
Food & Supplies $ x = $ Earnings from P/T job outside campus = $
Personal Items $ x = $ Government Income: (Orphan’s Benefits,
Transportation - Local $ x = $ Employment Insurances, etc...) = $
- to visit Home $ x = $ Other (i.e. pension, benefits...) = $
Unusual Expenses (i.e. medical, dental...) = $
FINANCIAL AID OFFICE USE ONLY:
Financial Aid Advisor’s Comments / Recommendation:
Total Expenses = $ Total Income = $
FINANCIAL NEED (Income - Expense) = $
Page 2 of 2
Approved for Work Study Plan No Yes: Amount $
TO BE DUPLICATED ONLY BY FINANCIAL AID AND AWARDS OFFICE.
Last Revised: October 24/12