OFFICE USE ONLY:

PERSONAL INFORMATION:
Street Address: Apt./Unit No.
City/Town: Province: Postal Code:
Home Telephone Number:
(Area Code)
Last Name: First Name:
Canadian Citizen
Permanent Resident/Protected Person
Citizenship Status:
Yes
No
Do you have a Permanent Disability:
Male
Female
Gender:
Campus: Percentage of a full course load: %

You may attach your RESUME to this application.

STUDENT DECLARATION:
Student Signature: Date:
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, nancial, 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.

EMPLOYER INFORMATION:
Position Title: Salary charged to: / / 0 1 4 8
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: Date:
Yes No OSAP:
Semester Program Status Transcript
Comments:
Yes No Returning WSP Student?
Yes No Emailed Employer?
Date:
Last Revised: October 24/12

TO BE DUPLICATED ONLY BY FINANCIAL AID AND AWARDS OFFICE.
Page 1 of 2
The objective of the Work Study Plan (WSP) is to help students
with nancial need meet their educational costs by working part-
time at the College during the study year and is administered
by designated staff in the Financial Aid Ofce. Your personal
information is collected on this form to determine your eligibility,
as well as your OSAP le 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 Ofce at (416)
491-5050 extension 77846 or email privacyofce@senecacollege.
ca. The mailing address for the Privacy Ofce is 8 The Seneca
Way, 7th Floor, Markham, Ontario, L3R 5Y1.
Student Number: Social Insurance Number:
International Work Study Plan Application Form
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: (Orphans Benets,
Transportation - Local $ x = $ Employment Insurances, etc...) = $
- to visit Home $ x = $ Other (i.e. pension, benets...) = $
Unusual Expenses (i.e. medical, dental...) = $
Total Expenses = $ Total Income = $
FINANCIAL NEED (Income - Expense) = $

STUDENT PERSONAL & FINANCIAL INFORMATION:
What year did you nish high school:
Marital Status:
Yes
Single Dependant: Less than 4 years out of high school (Complete SECTION A below)
Do you live with your parents?
Single Independant: More than 4 years out of high school (Complete SECTION B below)
No
Married/Common-law Divorced/Separated/Widowed Sole Support Parent

FINANCIAL INFORMATION: COMPLETE ONE SECTION ONLY.
Number of dependants in family still attending
school (including self) or who have a disability:
SECTION A: SECTION B:
Number of dependants:
Ages: Ages:
Number of above at post-secondary institutions (including self):
-- OR --
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?
Yes b) Do you have a part-time or full-time job outside campus? 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

FINANCIAL AID OFFICE USE ONLY:
Last Revised: October 24/12

TO BE DUPLICATED ONLY BY FINANCIAL AID AND AWARDS OFFICE.
Page 2 of 2
Financial Aid Advisors Comments / Recommendation:
No Approved for Work Study Plan Yes: Amount $