Apply Now – Holborn Scholars Foundation

Please take the time to review the entire application before responding and ensure you have the required information.

Please note the following:

You can only submit this form once.
You cannot save and edit your answers at a later date.
The deadline to submit the student application is April 16, 2019 11:59 pm (EST).
Late applications will not be accepted.

If you have any questions about the form, please contact scholarships@hsfcan.org

Section A: Student Personal Information

Last Name (required)

First Name (required)

OUIC-ID (required)

Student Number (required)

Your Email (required)

Telephone Number (required)

Country of Citizenship (required)

Section B: Student's Current Status Information

Check the ONE statement that BEST describes you:
B1. You are married (Your spouse will be required to provide their financial information.) (required)

B2. You are in a common-law relationship. (Your spouse will be required to provide their financial information.) (required)

B3. You are a sole-support parent. (You must have in your possession, a legal separation agreement, or a copy of your divorce judgement, or an affidavit confirming that any children will be living with you full-time during your study period, and/or a copy of your spouse's death certificate, if applicable) (required)

B4. You are separated, divorced, or widowed, AND you have NO dependent children living with you. (You must have in your possession one of the following: a legal separation agreement, a divorce judgement, or a copy of your spouse's death certificate.) (required)

B5. You are a current Crown ward or a former Crown ward who has not been adopted. (You must have in your possession; a letter from the Children's Aid Society or a court order confirming this.) (required)

B6. BOTH your parents are deceased. (You must have in your possession a copy of your parents' death certificates.) (required)

B7. None of the above statements applies to you. (Your parent(s) will be required to provide their financial information.) (required)

Section C: High School Graduation

C1. When did you or will you last attend high school on a full-time basis? (required)
(yyyy/mm/dd)

Section D: Residency

Choose the ONE option that best describes your residency situation:

D1. I have always lived in Ontario, or Ontario is the last province I resided in for 12 consecutive months without being a full-time post-secondary student. (required)

D2. I reside in Ontario and have lived in Canada for less than 12 months. (required)

D3. Ontario is the last province my parent(s), step-parent(s), legal guardian(s), or official sponsor(s) have resided in for at least 12 consecutive months immediately before the last day of the month that classes begin for the most recent period of full-time studies. (required)

D4. I reside in Ontario and my parent(s), step-parent, legal guardian, or official sponsor(s) and I have resided in Canada for less than 12 months. (required)

D5. My spouse has always resided in Ontario or Ontario is the last province my spouse resided in for 12 consecutive months without being a full-time post-secondary student. (required)

D6. I reside in Ontario and my spouse and I have lived in Canada for less than 12 months. (required)

D7. None of the above statements applies to you (i.e. my permanent residence is outside of Ontario). (required)

Section E: Student's Financial Background

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E1. Enter your estimate of the GROSS income from all sources that you expect to receive
during your pre-study period.

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E2. Enter the total value of your Registered Retirement Savings Plan (RRSP), as of the date 16 weeks before your 2019-2020 study period.

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E3. Enter the total value of all other investments (GIC's, bonds, terms deposits, etc.) and saving account balances as of the date 16 weeks before your 2019-2020 study period.

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E4. Enter the GROSS market value for any motorized vehicle(s) you own or lease.

Section F: Student Information During Study Period

F1. Where will you live during your study period?
F1A. At home with parent(s). (required)

F1B. Away from home in residence or off-campus rental. (required)

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F2. Enter the total estimated GROSS employment income you expect to receive during your study period.

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F3. Enter the total known income from scholarships, bursaries, and awards you expect to receive during your study period.

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F4. Enter the contribution expected from either a Registered Education Savings Plan (RESP) or a Non-registered education saving plan (CST,USC) for your study period.

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F5. Enter the total estimated value of all other income not already included.

Section G: Information from Parents(s)

If you checked item B7, your parent(s), step-parent, or legal guardian(s) must complete this section. "Father" refers to father, step-father, or legal guardian, or official sponsor. "Mother" refers to mother, step-mother, or legal guardian, or official sponsor.

G1. What is the CURRENT marital status of your parent(s)?
G1A. Married, remarried, or in a common-law relationship (both parents must complete the income tax information requested below) (required)

G1B. Divorced, separated, widowed, single (one parent must complete the income tax information requested below) (required)

G2A. How many dependent children, including you, are there in your family as described in item G1 (e.g., 1,2,3)?

G2B. How many dependent children, including yourself, are there in your family as described in item G1 who will be registered at a college or university in September (e.g., 1,2,3)?

G3. Enter the annual income for each parent, as reported on the 2018 Canadian individual income tax return. (Enter amounts in dollar only; do not indicate cents. If amount is negative, enter zero.)

What is father's (or parent 1) income reported on line 150 of his 2018 income tax return?

$ G3A1. What is father's (or parent 1) income reported on line 150 of his 2018 income tax return?

$ G3A2. What is mother's (or parent 2) income reported on line 150 of her 2018 income tax return?

$ G3B1. What is father's (or parent 1) income reported on line 236 of his 2018 income tax return?

$ G3B2. What is mother's (or parent 2) income reported on line 236 of her 2018 income tax return?

$ G3C1. If father (or parent 1) did not file a 2018 income tax return and/or has any other income not reported on his return, enter the total value of all other 2018 income. (e.g., non-taxable income, lottery winnings, insurance payouts, foreign income, child support payments)

$ G3C2. If mother (or parent 2) did not file a 2018 income tax return and/or has any other income not reported on her return, enter the total value of all other 2018 income. (e.g., non-taxable income, lottery winnings, insurance payouts, foreign income, child support payments)

G3D. Please explain how you met daily living requirements with a total family income of less than $6200 for 2017.

G4. Enter the amount of non-refundable tax credits and tax payable for each parent, as reported on his or her 2018 Canadian individual income tax return. (Enter amounts in dollars only; do not include cents.) Canadians Only

$ G4A1. What is father's (or parent 1) Canada Pension Plan contribution indicated on lines 308 and 310 of his 2018 income tax return?

$ G4A2. What is mother's (or parent 2) Canada Pension Plan contribution indicated on lines 308 and 310 of her 2018 income tax return?

$ G4B1. What is father's (or parent 1) Employment Insurance premiums indicated on line 312 of his 2018 income tax return?

$ G4B2. What is mother's (or parent 2) Employment Insurance premiums indicated on line 312 of her 2018 income tax return?

$ G4C1. What is father's (or parent 1) total tax payable indicated on line 435 of his 2018 income tax return?

$ G4C2. What is mother's (or parent 2) total tax payable indicated on line 435 of her 2018 income tax return?

G5. Is one or both of your parents' 2018 income is substantially less than their 2017 income? If yes, please indicate the total gross income amount(s) and have your parent(s) explain why.

Section J: Source of Government Income(Canadians Only)

J1. Was any of the income reported in this application from provincial social assistance?

J1A. No income reported was from government benefits

J1B. Ontario Disability Support Program (Family Benefits for Disabled - GAINS D)

J1C. Family Benefits

J1D. Ontario Works

J1E. Other (Specify)

Section K: Authorization to Release Information

K1. If you are selected for an award where one of the criteria has a financial need component, could we provide the donor of the award your name and program information? This decision will not affect your eligibility for award consideration.

K1A. Yes

K1B. No

Submit Form

Personal information is collected under the authority of Holborn Scholars Foundation, and in accordance with Ontario's Freedom of Information and Protection of Privacy Act (FIPPA). This information is used for the purpose of determining eligibility for scholarships/grants. For details on the use and disclosure of this information contact Student Financial Assistant at scholarships@hsfcan.org.

I certify that the information contained in this application is complete and true. I agree to provide Student Financial Services with any documentation necessary to verify the above noted information. I understand that failure to provide such documentation may affect current or future eligibility for the financial need-based programs. I further understand that should my eligibility for the financial need-based program be terminated.

B2 Help. You are considered to be in a common-law relationship if (a) you and your spouse have been in a relationship for not less than 3 years, or (b) you and your spouse are living together in a conjugal relationship and raising any children of whom you are both the natural or adoptive parents.

B3 Help. You are considered a sole-support parent if you have any dependent children living with you on a full-time basis during your study period, AND you are single, separated, divorced, or widowed.

E1 Help. Definition of Pre-study period: If you were a full-time high school student in 2018-2019, your pre-study period is the time between the end of your last study period and the start of your 2019-2020 study period. If there are fewer than 16 weeks, enter the income received during the actual number of weeks. OR If there are more than 16 weeks between these 2 periods, enter the income received during the 16 weeks immediately before the start of your 2019-2020 study period.

If you were not a full-time high school student, your pre-study period is the 16 weeks immediately before the start of your 2019-2020 study period.

G1A Help. If you are living with both of your natural parents, your father and mother must complete this section. If you are living with only one of your natural parents, this natural parent and his or her spouse, if any, must complete this section.

G1B Help. The parent with whom you currently live OR last lived, OR who last supported you, must complete this section.

G2 Help. Dependent children are children with disabilities, pre-school children and children attending elementary or high school who are under 16 years of age. Children 16 years or older must be a full-time (taking 60% or more of a full course load) high school or postsecondary student to be considered dependent. Children who do not have a disability and who have been out of high school for 4 or more years are not considered dependent.

G3 Help. If both parents are completing this section and the total combined income entered in items G3A, G3C is less than $6,200, the parents must indicate how the family's daily living costs are being met.

If only ONE parent is completing this section and the total income entered in items G3A, G3C is less than $6,200, that parent must indicate how the family's daily living costs are being met.

G4C Help. If you entered data on line 421 and/or 422 of your 2018 income tax return, subtract this amount(s) from line 435. Enter this revised amount in item G4C.

G5 Help. Completing this section should be done for extenuating financial circumstances beyond your family's control. Some examples of this may be, but not limited to; loss of job, if 2018 income included severance pay or significant insurance payout, or retirement.