ISBP Application Form

Application Checklist*
- I have my supporting documents ready for upload.
- My supporting documents are in English or French. If they are in a foreign language, I have the original document and an official translation in English or French ready for upload.

Choose a program:*
Study period Start date (DD/MM/YYYY):*
DD slash MM slash YYYY

Personal Information
First Name*
Last Name*
Address:*
Apartment Number - Street Number and Street Name City Province Postal Code
Email address:*
Student Number:
If you do not yet have an Algonquin College student number, please leave blank.
Telephone:*
Date of Birth (DD/MM/YYYY):*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Prefer Not to Answer

Previous Post-secondary Education
Have you ever attended a post-secondary program at a college or university?*
Academic Upgrading is not considered post-secondary program.
- Yes
- No
What is the name of the college or university you attended?*
What is the name of the program you attended?*
Did you graduate?*
- Yes
- No
If you graduated, in which country did you complete your studies?*

Citizenship Status
Citizenship Status*
(attach proof for sections marked with an *)
Proof of Citizenship*
Max. file size: 5 MB.
Permanent Resident: You must provide an electronic copy of your Canada Immigration Record or a photocopy of the front and back of your Permanent Resident Card.
Protected Person or Convention Refugee: You must provide an electronic copy of one of the following:
• Protected Persons Status document OR
• Verification of Status document OR
• Notice of Decision document

Marital Status
Marital Status*
(attach proof for sections marked with an *)
Proof of Marital Status*
Max. file size: 5 MB.
Married: Electronic copy of your marriage certificate or a jointly-signed legal affidavit.
Common-law: Electronic copy of a joint legal affidavit.
Separated: Electronic copy of your legal separation agreement or court order, or a legal affidavit.
Divorced: Electronic copy of your divorce judgment, court order or a legal affidavit.
Sole-support/Widowed with children: Electronic copy of a legal affidavit confirming that you are a sole-support parent or widow(er).

For the purposes of the ISBP, a common-law relationship exists when:
You have cohabitated continuously for a period of at least 3 years OR
You are in a relationship of some permanence and are the natural or adoptive parents of a child.

Dependent Children
Do you have dependent children?*
- Yes
- No
For the purposes of the ISBP, a dependent child is when:
The child is under 18 years of age and living with you for 50% or more of your study period OR
The child is over 18 years old and is living with you for 50% or more of your study period and is a full-time student in high school or post-secondary OR
The child has a disability and is wholly dependent on you (and spouse, if applicable)
Proof of date of birth:*
Drop files here or

Max. file size: 5 MB, Max. files: 6.
Dependent children: You must provide an electronic copy of one of the following for each dependent child:
• Birth Certificate OR
• Passport OR
• Permanent Residence card

Applicant Income
Total gross income for the 2022 year (Notice of Assessment, Line 150) NOTE: Your T1 General or a T4 are NOT acceptable documentation*
Proof of Income:*
Max. file size: 5 MB.
All applicants must submit their Notice of Assessment (NOA) for 2022 with the exception of students who did not reside in Canada during 2022.

If you did not live in Canada during 2022, please submit proof of current income, dated within 90 days of the start of classes.

Do you currently receive government funding?*
- Yes
- No
Source of government income:*

Spouse Income
Name of spouse:*
First Last
Date of birth of spouse:*
YYYY slash MM slash DD
Total gross income for the 2022 year (Notice of Assessment, Line 150)*
Proof of Spouse's Income:*
Max. file size: 5 MB.
All applicants must submit their spouse’s Notice of Assessment (NOA) for 2021. If your spouse did not live in Canada for 2021, please submit proof of their current income, dated within 90 days of the start of classes.

Student Declaration:*
- I hereby declare that the information submitted is true and correct. I have read and understood the eligibility requirements and the instructions.
I authorize Algonquin College to collect, use and disclose personal information to determine my eligibility for ISBP.
I authorize Algonquin College to disclose and collect personal information to verify that I am not in receipt of other financial aid assistance (OSAP, Second Career or Out-of-Province funding).
I authorize Algonquin College to disclose personal information if I apply for BSWD (Bursary for Students with Disabilities) during my study period.
Spouse Declaration:*
- I hereby declare that the information submitted is true and correct.
I authorize Algonquin College to disclose personal information if my spouse applies for BSWD (Bursary for Students with Disabilities) during their study period.
I authorize Algonquin College to collect, use and disclose personal information to determine my spouse’s eligibility for ISBP.
To formalize compliance with the Freedom of Information and Protection of Privacy Act, Algonquin College requires that you read the statement below. The information gathered through this document is collected under the legal authorization of the Ontario Colleges of Applied Arts and Technology Act, 2002, S.O. 2002, Chapter 8, Schedule F, Section 6. The information is used for educational, administrative and statistical purposes of the College and/or ministries and agencies of the Government of Ontario and the Government of Canada. Administrative purposes may include the disclosure to or on behalf of the Students’ Association of Algonquin College for the purposes of the activities of the Association or to establish qualifications for benefits such as drug plan cards, OC Transpo passes or Alumni Association. The College publishes the names of students who graduate and/or achieve academic excellence. For questions related to this policy, please contact the Registrar, 1385 Woodroffe Avenue, Ottawa, ON, K2G 1V8 or (613) 727-4723. Under the Privacy Act, individuals can request access to their own, individual information held on federal banks, including those held by Statistics Canada. Students who do not wish to have their information used may ask Statistics Canada to remove their identification and contact information from the national database. Further information on the use of this information can be obtained from Statistics Canada’s website: http://www.statcan.ca or by writing to the Postsecondary Section of Statistics Canada, Centre for Education Statistics, 17th Floor, R.H. Coates Building, Tunney’s Pasture, Ottawa, K1A 0T6.
Name
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Financial Aid
& Student Awards

ISBP Application Form

Institution-Funded Special Bursary Program (ISBP) Application - updated

Step 1 of 11

Personal Information

Previous Post-secondary Education

Citizenship Status

Marital Status

Dependent Children

Applicant Income

Spouse Income

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