Estimates must be attached to this application for each service requested. Estimates must include the following:
Note regarding tablets:
You must choose either a tablet or a laptop, but not both. You may be funded once every five years only for either device. A tablet will only be approved if the documentation provided demonstrates that it performs a function(s) specific to your disability-related need that cannot be performed by another device, at a similar cost.
Section D: Student Consents, Declarations and Signature
Notice of Collection and Use of Personal Information
Your personal information, including your Social Insurance Number (SIN), provided in connection with your student profile, this application and any previous applications and awards of financial assistance will be used by the Ministry of Training, Colleges and Universities (ministry) to administer and finance the Bursary for Students with Disabilities (BSWD) program and by Employment and Social Development Canada (ESDC) to administer and finance the Canada Student Grant for Services and Equipment for Persons with Permanent Disabilities (CSG-PDSE) program. Your SIN will be used as a general identifier in administering the BSWD/CSG-PDSE. The ministry and ESDC may use other parties for any of these activities. Under agreement with the ministry, your postsecondary school and, where authorized by the ministry, its agents who administer OSAP and its auditors use your personal information to administer the BSWD/CSG-PDSE.
Administration includes: determining your eligibility for a BSWD/CSG-PDSE award; verifying your application and supporting documentation, including verifying financial assistance provided under any other ministry program; paying your award; verifying your award; auditing your file; assessing and collecting overpayments; enforcing the legislation set out below and your agreements with the ministry and ESDC; and monitoring and auditing your postsecondary school or its authorized agents to ensure that they are administering the programs appropriately. In addition, administration by the ministry and ESDC includes public reporting on the administration and financing of student assistance programs; planning, delivering, evaluating and monitoring student assistance programs for quality and improvements in both content and delivery; conducting risk management, error management, audit and quality assessment activities; conducting inspections or investigations; and conducting policy analysis, evaluation, and research related to all aspects of the BSWD/CSG-PDSE, including contacting you to participate in surveys. Financing includes: planning, arranging or providing funding of the BSWD/CSG-PDSE.
The ministry administers the BSWD under the authority of s.5 of the Ministry of Training, Colleges and Universities Act, R.S.O. 1990, c.M.19, as amended and s. 10.1 of the Financial Administration Act, R.S.O. 1990, c.F.12, as amended, and the CSG-PDSE under the authority of the Canada Student Financial Assistance Act, S.C. 1994, c.28, as amended, and the Canada Student Financial Assistance Regulations, SOR 95-329, as amended and s. 266.3(4) of the Education Act. If you have any questions about the collection or use of this information, contact the Director, Student Financial Assistance Branch, Ministry of Training, Colleges and Universities, PO Box 4500, 189 Red River Road, 4th Floor, Thunder Bay, ON P7B 6G9, (807) 343-7260.
Applicant's Consent to the Indirect Collection, Use and Disclosure of Personal Information (REQUIRED)
I agree that until I provide receipts for and/or repay BSWD/CSG-PDSE funds provided to me, and until any BSWD/CSG-PDSE overpayments are assessed and repaid, the ministry can, without limitation, collect and exchange personal information about me that is relevant to the administration and financing of BSWD/CSG-PDSE with ESDC, my postsecondary school and its authorized financial administrators and auditors; the ministry's contractors, auditors or other authorized third party administrators; collection agencies operated or retained by the federal or provincial government, and consumer reporting agencies.
I understand that I can withdraw any consent I have given in this section by writing to the Director, Student Financial Assistance Branch at the address above at any time before I accept a BSWD/CSG-PDSE award. I understand that if I withdraw my consent it will affect my eligibility for and the amount of BSWD/CSG-PDSE assistance.
Applicant’s Declaration (Please read carefully)
I require BSWD/CSG-PDSE funding for the cost of the disability-related services and/or equipment identified on this application, and I will not receive financial assistance from any other source to cover these costs.
I understand that I must use the BSWD/CSG-PDSE I receive for the equipment and/or services identified on this application and that I cannot substitute for any other equipment and/or services not identified on this application.
I agree that I will provide receipts for equipment and software no later than 30 days after being issued BSWD/CSG-PDSE funds, and I agree that I will provide receipts for services no later than 30 days after the end of my OSAP study period. I will submit these receipts to my postsecondary school’s Financial Aid Office or to the ministry, as instructed in the “Where To Send Your Application” section of this application form, and will show that BSWD/CSG-PDSE funds were spent for their approved purposes.
I agree that if I do not submit receipts I will repay, by money order or certified cheque to my school’s Financial Aid Office or to the Minister of Finance, any BSWD/CSG-PDSE funds that I have not used for the OSAP study period identified on this application. I understand that failure to do so may result in being restricted from receiving OSAP, including BSWD/CSG-PDSE funding, and the 30% Off Ontario Tuition grant.
I understand that I may be required to repay all or part of the BSWD/CSG-PDSE funds if the information and any supporting documentation I provide in connection with this application is found to be inaccurate or if any information I provide changes, including my OSAP study period and/or my course load.
I understand that information I provide in connection with this application will be verified and audited and any change resulting from verification and audit may affect my eligibility for and the amount of BSWD/CSG-PDSE funds provided to me, and that I may be required to repay all or a part of the BSWD/CSG-PDSE funds.
I have given complete and true information on this application form and I understand that if I fail to provide complete and true information and/or fail to promptly notify my Financial Aid Office or the ministry through my account on the OSAP website or in writing of changes to any information I have provided, including my disability and the services and equipment I need, my address and/or financial, academic, family, and/or OSAP study period status; or fail to fulfil any obligations respecting the repayment of any overpayments, the ministry may restrict me from receiving OSAP, including BSWD/CSG-PDSE funding, and/or the 30% Off Ontario Tuition grant in the future, and may take legal action and may require me to repay any assistance that I received.
I will keep a copy of my application and all required supporting documentation in the event that I am required to produce this information for audit, verification, inspection, or investigation purposes.
I have read and understood this section, including the notice of collection, use and disclosure of my personal information and my signature attests to my consent to the indirect collection, use and disclosure of my personal information.
Signature of Applicant:
Date:
Section E: Publicly Assisted Ontario College or University Approvals
Part one: Office for Students with Disabilities Approval
I hereby confirm that:
Name of Disabilities Office Coordinator/Counsellor:
Signature
Date
Part two: Financial Aid Office Approval
I hereby confirm that the above named student:
Has $1.00 of financial need under one of the programs identified in Section B of this application;
Has provided all supporting documentation for this application; and
Is enrolled and registered at this postsecondary school for the study period identified on this application.
Name of Financial Aid Administrator:
Signature
Date
Section F: Private or Out of Province Postsecondary School Approvals
Financial Aid Office Approval
I hereby confirm that the above named student:
Is enrolled and registered at this postsecondary school for the study period identified on this application.
Name of Financial Aid Administrator:
Signature
Date