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In-course scholarship budget sheet

* required Indicates a field that must be filled.

Contact information

Student number (ie V00123456):

Last name (family/surname): *

First name (given name): *

Email address: *

Level of study:

Undergraduate Graduate

Marital status:

Single Married/Common-law

Is your spouse a student at UVic:

Yes No

Is your spouse studying at another institution? If so, please specify:

Number of dependent children living with you:

While attending UVic, I will be living: *

Study period: *

Budget Sheet

Total number months of study in the academic year:

Education expenses

Tuition:

Books:

Supplies:

Thesis/Dissertation binding:

Total education expenses:

Monthly expenses

Housing (rent/mortgage):

Food:

Utilities:

Household (laundry, cleaning etc):

Transportation:

Entertainment:

Medical/Dental/Optical:

Actual child care costs (before subsidy):

Other:

Total monthly expenses:

Total monthly expenses X Total number months of study

Total expenses:

Education resources

Savings:

Awards (Scholarships & Bursaries):

Student Loans/Grants (projected):

Fellowships/Research grants:

Total education resources:

Monthly income

Part-Time earnings:

Work study/Co-op earnings:

Assistantships (TA & RA) earnings:

Sponsorships:

Orphan's benefits/CPP:

Family contribution (parents or other family members):

Spouse's contribution (net income from all sources):

Child care subsidy:

Other:

Canada Child Benefit (CCB):

Total monthly income:

Total monthly income X Total number months of study:

Total resources:

Budget Summary

Financial Need (Total Expenses - Total Resources):

I hereby declare that all information given above is complete and true in every respect, and that I have answered all questions applicable to me on this form. I further declare that I am willing to submit all statements for independent verification and audit and that I will submit any documentation necessary to substantiate my claimed income and expenses. I understand that a scholarship or award granted on the basis of this application may be revoked if the information given above is untrue in any material respect.