Scholars and Students at Risk Award Program

PERSONAL INFORMATION

First Name

Last Name

Email Address

U of T Student Number

Marital Status

Single

Married/Common Law

Separated/Divorced

Status in Canada

Canadian Citizen/Permanent Resident

Student Authorization

Other

Do You Have Any Dependent Children Living With You?

Yes

No

Please Specify What is Your Status in Canada

Number of Dependent Children Living With You

Ages of Dependent Children Living With You

Have You Received Scholars at Risk Funding Before?

Yes

No

ACADEMIC INFORMATION

Faculty/College

Program/Area of Study

Year of Study

Credits in Current Academic Year

Expected Date of Graduation (mm/yyyy)

Current Level of Studies

Graduate

Undergraduate

ADDITIONAL INFORMATION

Please describe your status as either an asylum seeker or refugee or how your proposed program of study has been impacted by changing political environments in your country of current or future study, including changes in immigration law. Please include your date or estimated date of entry into Canada, and any financial challenges you face in pursing your academic goals.

Some grants are funded by private donors who wish to receive limited information about the recipient(s). This could be general, biographical and/or academic in nature. Do you consent to the release of such information?

Yes

No

DECLARATION

I hereby certify that the information provided on this application is, to the best of my knowledge, true and complete, and I authorize the release of the information contained herein to the appropriate Grant Selection Committee.

The University of Toronto respect your privacy.

The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. At all times it will be protected in Accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy or contact the University's Freedom of Information and Protection of Privacy Office at 416 946-5835, Room 201, McMurrich Bldg., 12 Queen's Park Crescent, Toronto, ON, M5S 1A1