FOS COVID-19 STUDENT EMERGENCY FUND

The purpose of this fund is to provide some financial support in the form of a bursary to students facing financial hardship due to the current COVID-19 Pandemic crisis. Please thoroughly review the pre-screening criteria listed below, as these will be used to determine your eligibility prior to assessing your application.

Pre-screening Criteria: • You must be enrolled in undergraduate or graduate studies at the Faculty of Science,

University of Manitoba.• You must be a full-time or part-time Faculty of Science student in the current academic session.• You must have paid all tuition owing for both the current and from previous academic sessions.• You must have repaid all outstanding emergency aid from previous academic sessions.• You are not eligible if you have already received University of Manitoba Student Emergency

Covid-19 funding.• You must apply for this funding even if you applied previously but did not receive emergency funding.• You must be in Good Academic Standing in the Faculty of Science (i.e you cannot be on academic or

disciplinary suspension).Funding:

• Bursary values will not exceed $800 for full-time studies & $400 for part-time studies.

How to Complete This Form: For best results, please consider using the free Adobe Acrobat Reader to complete this form.

How to Submit This Form: Once you have filled out your form, email it from your University email address as follows:

Email Subject: COVID-19 App, <Your Name>, <Your Student Number> Email Address: FOS.C19Fund@umanitoba.ca

Applications will be reviewed by an Awards Officer, and only successful applicants will be informed of a decision. Awards notices will be sent to your University email address. Incomplete applications will not be reviewed.

Notice Regarding Collection, Use, and Disclosure of Personal Information by the University Your personal information is being collected under the authority of The University of Manitoba Act. The information you provide will be used by the University for the purpose of determining eligibility for the bursary, for administrating the bursary, and for communication. Your personal information will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act (FIPPA). If you have any questions about the collection of your personal information, contact the Access & Privacy Office (tel. 204-474-9462), 233 Elizabeth Dafoe Library, University of Manitoba, Winnipeg, MB, R3T 2N2.

Page 1 of 3

Faculty of Science 186 Dysard Road| Winnipeg, Manitoba, Canada R3T 2N2 | Phone: 204-474-8256|

Personal Information Name (Last, First)

/Student Number Year in Program

Street Address Faculty

City/Town Program

Province Postal Code Name of Spouse/Significant Other/Partner:

Sessional Phone No.: Names and Ages of Dependants:

Permanent Phone No.:

U of M email

Reason for Request Please state your reason for your request in detail. You may attach up to one additional page.

Cash Flow Statement Please provide income information for the period of September 1, 2019 to April 30, 2020. You may have to estimate some of the figures such as employment income and income tax.

Applicant Spouse (if applicable)

Total Student Aid (government student loans and grants) $ $

Other Awards (bursaries, scholarships and prizes) $ $

Child Tax Benefit and/or Family Allowance $ $

Assets (cash savings, bank accounts, bonds, stocks, RRSPs) $ $

Other Income (Work earnings, investments, rental, Worker’s Comp, EI, etc.) $ $

Contributions From Relatives (Excluding room & board) $ $

Sponsor (monthly funding amount) $ x (Months of Study) = $ ----

Income Tax Refund (Estimate) $ $

(Sum of all amounts above, Applicant & Spouse) Total Income for the Session $

Emergency Assistance Application

Page 2 of 3

Academic Expenses Student Aid - through your home province, did you apply for student aid this year? Yes No

Length of Your Academic Session in Number of Months: Full Tuition $

Books & Supplies $

Total Academic Expenses $

Expenses for One Month Please provide expense information that applies to you for a one-month period. You may need to estimate variable expenses such as groceries, laundry, clothing, entertainment, etc.

Do you own/lease a vehicle? Yes No

Rent/Mortgage $ Entertainment $

Utilities $ Vehicle Fuel Costs $

Phone Bill $ Vehicle Insurance $

Groceries $ Parking $

Laundry $ Credit Card(s) $

Toiletries $ Personal Loans $

Other (enter a description): $

Total Monthly Expenses $

Emergency Assistance Application

Page 3 of 3

Emergency Assistance Application Faculty of Science - OFFICE USE ONLY

All fields on this application are mandatory. Incomplete applications will not be processed.

Monthly Cash Flow Summary Total Income for the Session $

Net Resources for the Session = Total Income – Total Academic Expenses $

Monthly Budgeted Amount = Net Resources ÷ Length of Academic Session $

Total Monthly Expenses $

Budgeted surplus or deficit per month = Monthly Budget Amount – Monthly Expenses $

Bursary Approved: Yes No Amount $

___________________________________________ __________________________________________Deans Signature (or Designate) Date of Approval

Notes: