Youth in Care Bursary Pilot Program Summer 2018 Application Registrar & Enrolment Services Starting in Fall 2014, the Youth in Care Bursary Pilot Program has been offered as a four (4) year pilot program. The Youth in Care Bursary is intended to assist with educational costs for students who are living or have lived as youth in care in British Columbia. Bursaries are subject to available funds. Eligibility Criteria: Is a resident of British Columbia who has received care from the Ministry of Children & Family Development or a Designated Aboriginal Agency in one of the following ways through the Child, Family, and Community Service Act (CFCSA): o a continuing Custody Order pursuant to sections 41(1)(d), 42.2(4)(d) or (7) or 49(4),(5), or 10(a) of the Act for a minimum of one year o a Youth Agreement pursuant to section 12.2 of the Act for at least 1 year or on their 19 th birthday o a Transfer of Custody Order pursuant to section 54.01 or 54.1 of the Act If you are not aware whether you meet the above criteria, please contact your former social worker, any Ministry of Children and Family Development office, or any delegated Aboriginal Agency. Currently is, or has been accepted as, a Regular Studies student. Funding will be targeted to students completing their first academic credential, or first bachelor degree program. Is enrolled in, or will be enrolling in, a minimum of a 60% courseload (or 40% for students with disabilities) Is in Good Standing 1 If a returning student, holds a cumulative GPA of 2.00 or higher Has demonstrated financial need as per the Langara bursary formula 2 Is 19 years of age or older at the beginning of the study term If approved, the Youth in Care Bursary will cover up to the total of tuition fees, Material/Lab Fees, and the Capital Building Legacy Fees for the semester approved. Langara reserves the right to prorate the bursary based on financial need of the applicant and available funding. 1 For the purpose of this bursary, the Registrar defines a 'student in good standing' as a person who: I. is not on academic suspension or required to withdraw from all courses; II. has not been suspended or expelled from the College for any reason. 2 Students are required to apply for the Youth Education Assistance Fund (if eligible) and provide a minimum contribution through government student loans, grants, or other personal funding. Page 1 of 4
Youth in Care Bursary Pilot Program Summer 2018 Application Registrar & Enrolment Services It is the student s responsibility to ensure this application is completed in full. Incomplete applications including a lack of signature may result in disqualification for the bursary. An Unofficial Transcript is required and can be printed through your mylangara account. Completed forms must be submitted to the Langara Financial Aid Office as soon as possible. Please complete in ink. STUDENT INFORMATION LANGARA ID: SIN NUMBER: LEGAL SURNAME: LEGAL FIRST NAME: GENDER: Male Female Other MAILING ADDRESS: DATE OF BIRTH: (mm/dd/yyyy) CITY: PROVINCE: POSTAL CODE: EMAIL: PHONE: PROGRAM OF STUDY: CONCENTRATION, DEGREE OF STUDY, OR CO OP: While in studies, will you be living with your parent(s)/stepparent/ legal guardian or live in a home rented or owned by them? MARITAL STATUS (CHECK ALL THAT APPLY) *If you are a single parent and living common law, please check both boxes Single Separated/Divorced Married Single Parent Common law NUMBER OF DEPENDANTS: AGES: If you are a single parent, are your children living with you? I wish to declare that I am of First Nation s ancestry. (Please provide a copy of your Metis card, Status card, or other Aboriginal ID) Do you have a permanent disability with StudentAid BC or are you currently registered with Langara Disability Services and receiving academic accommodations? Page 2 of 4
COMPLETE SPENDING PLAN FOR THE CURRENT SEMESTER ONLY Estimated Resources Available for Entire Summer Term Estimated Expenses for You (and Spouse/ Common law Partner) for Entire Summer Term Savings as of May 7, 2018 (Do not include student loan funding) Tuition Net Income During Academic Term Books and Supplies Government Student Loans Rent or Mortgage (Please note that if you live with your parent/ stepparent(s) and pay rent, please supply copies Government Student Grants of bank statements for the last 4 months to support the expense stated) EI/PWD/Income Assistance Utilities (Cell, internet, hydro, etc.) Sponsored Funding (e.g. AYA or band funding) (Including living costs, tuition, and books) Financial Assistance from Parents or Other Family Spouse/Common law Partner s Net Income Line of Credit (If you or someone on your behalf is using a line of credit to pay for books, etc. enter the amount here) Childcare Subsidy GST Rebate and/or Child Tax Benefit Any Other Income Resources Food Clothing Miscellaneous (e.g. hygiene, household, fitness) (Must detail below) Childcare (Include subsidy) Transportation (Must detail below) Medical/Dental (Not covered by the Langara Medical/Dental Plan) (Must detail below and submit receipts) Exceptional (Must detail below and submit receipts) Please note that miscellaneous/exceptional/ transportation/ medical/dental expenses will not be considered unless they are detailed below Total Resources Total Expenses TOTAL RESOURCES MINUS ( ) TOTAL EXPENSES (=) TOTAL NEEDED: Please note that this application will not be considered unless the following expenses are detailed and receipts are received. Medical/Dental Expenses: (Receipts are required please enclose with application) Miscellaneous Expenses: (Receipts may be required) Exceptional Expenses: (Receipts are required please enclose with application) Transportation Expenses: Page 3 of 4
Please explain what circumstances have made it necessary for you to apply for a bursary. (Attach an additional page if necessary) Please detail if you have a financial emergency (Attach an additional page if necessary) COLLECTION, USE, AND DISCLOSURE OF STUDENT INFORMATION 1. All information provided on this application is complete, accurate, and truthful to the best of my knowledge. 2. Langara College collects the information on this form under the authority of the College and Institute Act [RSBC 1996, Ch. 52, S. 41.1]. Financial Aid Services will use and disclose the information to review, process, and award bursaries to eligible students in compliance with the provisions of the Freedom of Information and Protection of Privacy Act [RSBC 1996, Ch. 165]. A Financial Aid Advisor or designate may disclose the contents of this application to any organization or employer listed as a source of income, or the source to which any of the expenses on this application are attributed, e.g., landlord, dentist, day care, etc. Any information disclosed in this application is subject to audit and you may be asked to provide proof of any expenses or income listed in the application. 3. I give permission to the Financial Aid Advisor or her/his delegate to discuss the contents of this application with a person delegated by Langara College to verify information with my Child and Youth Care Agency. 4. With your consent, a Financial Aid Advisor or designate may disclose your personal information, including your name and program, to the donor of any bursary awarded. The donor may use the information for auditing or reporting purposes. Direct questions about compliance with the Freedom of Information and Protection of Privacy Act to the Assistant Registrar, Financial Aid Services, Langara College, 100 West 49th Avenue, Vancouver, B.C. V5Y 2Z6, Phone: 604.323.5095. STUDENT S SIGNATURE: OFFICE USE ONLY DATE: DATE RECEIVED: FEES PAID: AMOUNT OWING: # OF SEMESTERS (Excluding current term): GPA: # OF CREDITS THIS SEMESTER: COMMENTS: TOTAL NEED: FAO INITIAL: AWARD DECISION: Approved Denied DONOR: FUND: AMOUNT: AMOUNT PAID TO STUDENT S ACCOUNT: AWARD ENTERED BY: STUDENT S SIGNATURE (Cheque received): Page 4 of 4
Youth in Care Bursary Pilot 2018 Authorization for Release of Information I born Student name Month, Day, Year hereby authorize the exchange of information between the Ministry of Children and Family Development and Langara College as it relates to the Youth in Care Bursary Pilot Program and to records such as: Notice that I am an applicant and/or recipient of the Program from Langara College; Confirmation of application of admission to Langara College; Confirmation of eligibility for the Youth in Care Bursary as a current or former youth in care as defined in the Child, Family, and Community Service Act I understand that this information will be used to determine eligibility for the Youth in Care Bursary Pilot Program based on the below criterion: Is a resident of British Columbia who has received care from the Ministry of Children & Family Development or a Designated Aboriginal Agency in one of the following ways through the Child, Family, and Community Service Act (CFCSA): o a continuing Custody Order pursuant to sections 41(1)(d), 42.2(4)(d) or (7) or 49(4),(5), or 10(a) of the Act for a minimum of one year o a Youth Agreement pursuant to section 12.2 of the Act o a Transfer of Custody Order pursuant to section 54.01 or 54.1 of the Act This consent is valid for one year from the date signed. Student Signature Date Langara College Representative Name and Title Langara College Representative Signature Date Page 1 of 1