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BURSARY APPEAL REQUEST Student Financial Aid and Awards 3700 Willingdon Avenue Burnaby BC Canada V5G 3H2 E finaid bcit. Ca T 604. 432. 8555 F 604. 454. 0941 Hours 0830 1600 Monday to Friday CLEAR FORM BCIT ID Social Insurance Number required for income tax purposes Last Name First Name Initial Street Address City Province Postal Code Program Name Level Telephone Note This form is for full-time students who applied for a BCIT Bursary and wish to appeal the decision. Submit Bursary Appeal Request to Student Financial Aid and Awards at the Burnaby Campus SW1 2132 by TUESDAY MARCH 15 2016 1. Attach a letter outlining why a reassessment of your situation is warranted* If your circumstances have changed since you submitted the original bursary application earlier this term outline reasons and provide documentation* Examples if you have had exceptional expenses not covered by insurance since you submitted the bursary application e*g* emergency dental work prescription costs car repair. Attach bill photocopies as documentation* if your income has changed since you submitted the bursary application e*g* no longer working part-time parents unable to provide funds originally promised or spouse became unemployed. Attach documentation* 2. Complete the following budget indicating your expenses and income from NOW to the end of your current term* If you are married or a single parent make sure you include the expenses and income for your entire family not just yourself* The budget covers the period from to date date EXPENSES Rent or mortgage INCOME Bank balance savings as of today Food Government loans/grants Utilities heat light phone cable Sponsor income Agency Band WCB etc* Transportation bus pass or car costs Part-time income/work study/EI Insurance Spouse s income or EI Loan payment specify Child Tax Benefit/BC Family Bonus Medical premiums/costs Daycare subsidy Daycare Child support Miscellaneous daily costs leisure Parent/family contribution Personal care haircuts toiletries clothing Other resources specify Other expenses specify TOTAL This information is collected for the purpose of evaluating your bursary appeal request. I hereby declare that the information I submitted on this application is true and correct. SFAA-10V3 2016 01 TOTAL EXPENSES Student signature minus TOTAL INCOME Date OFFICE USE ONLY Bursary Amount Account Initial REQUEST. Attach a letter outlining why a reassessment of your situation is warranted* If your circumstances have changed since you submitted the original bursary application earlier this term outline reasons and provide documentation* Examples if you have had exceptional expenses not covered by insurance since you submitted the bursary application e*g* emergency dental work prescription costs car repair. Attach bill photocopies as documentation* if your income has changed since you submitted the bursary application e*g* no longer working part-time parents unable to provide funds originally promised or spouse became unemployed.

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