Sample .ca

Human Resources and

Ressources humaines et

Skills Development Canada D?veloppement des comp?tences Canada

Certificate of Eligibility and Canada Student Loan Agreement

IMPORTANT - PLEASE READ REVERSE

PROTECTED B - WHEN COMPLETED

Province

AB

Provincial Use

2

Part A - YOUR INFORMATION

Student's Last Name, First Names and Mailing Address (While in School)

Date of Birth (yyyy/mm/dd)

Social Insurance Number

Permanent Address (if different from while at school)

Area Code and Telephone (while at school)

Area Code and Telephone (permanent address)

Part B - CERTIFICATE OF ELIGIBILITY Program of Study

E-mail Address of Student FOS Code

Institution Code

Number of Study Weeks

Period of Study

Provincial Student ID# Student ID Number Certificate Number

Name and Address of Designated Educational Institution (EI)

Disbursement Dates and Amounts Canada Student Loan

$CAD $

Canada Student Grants

$

Address and Telephone Number of National Student Loans Service Centre (NSLSC) Disbursement Date (not negotiable before this date):

(yyyy/mm/dd)

Period of Study Start Date:

Period of Study End Date (not negotiable after this date): Issue Date:

This certifies that the above-named student qualifies, as a Full-Time

le Student, for the issuance of this certificate in accordance with the

Canada Student Financial Assistance Act (CSFAA) and the Canada Student Loans Act (CSLA), as amended from time to time.

Signature of Appropriate Authority

Student Aid Alberta PO Box 28000 Stn Main Edmonton AB T5J 4R4 Toll-free: 1 855-606-2096

studentaid.alberta.ca

Part C - CONFIRMATION OF ENROLMENT (to be completed by the Educational Institution)

p This is to confirm that the above-named student is enrolled Full-Time as required by the Canada Student Financial Assistance Instructions to the EI:

Act (CSFAA) and Regulations and the Canada Student Loans Act (CSLA) and Regulations. We agree to promptly notify the

An "X" signifies that the above named

National Student Loans Service Centre (NSLSC) if the student ceases to be a Full-Time Student before the Period of Study End student with a permanent disability can be

Date by completing copy 3 of this document and forwarding it to the NSLSC or through another mutually agreed upon process. confirmed as enrolled Full-Time

at 40% of a full course load.

m Name, Title and Telephone Number a of Authorized Officer

Signature of Authorized Officer

Date Signed * (yyyy/mm/dd)

Instructions to the NSLSC: Remit this amount to the EI listed above

$ CAD

* Valid for only 30 days after date signed but not beyond Period of Study End Date.

Part D - ELECTRONIC FUNDS TRANSFER

S The approved amount of any Financial Assistance disbursed under this Canada Student Loan Agreement, less the remittance you have directed to your EI under Part C, will be

electronically deposited into your Canadian bank account as entered below, which must be held in your name, solely or jointly. Electronic withdrawals may also be made from this

bank account when payment is triggered, as per section H.6(c)(iii), subject to your right of revocation, as per section H.6(e). If you fail to provide your bank account information,

disbursement of your Financial Assistance will be delayed and may not proceed.

Name and Address of Financial Institution:

Transit Number

Bank ID

Account Number (Refer to the bottom of your personal cheque)

OR ATTACH A VOID CHEQUE

Part E - TERMS AND CONDITIONS OF YOUR CANADA STUDENT LOAN AGREEMENT

1. Agreement: This Student Loan Agreement is between you ("you" or "your"), as identified in Part A, and Her Majesty the Queen in Right of Canada, as represented by the Minister of Human Resources and Skills Development ("Canada"), made pursuant to the CSFAA and called the Canada Student Loan Agreement ("Canada-SLA"). In consideration of Canada providing Financial Assistance under this Canada-SLA, and, by signing Part F below, you agree to the Terms and Conditions of this loan contract. This Certificate of Eligibility and Canada-SLA is comprised of: Part A: Your Information Part B: Certificate of Eligibility Part D: Electronic Funds Transfer Part E: Terms and Conditions of your Canada Student Loan Agreement Part F: Your Acknowledgement and Signature Part G: Definitions Part H: Additional Terms and Conditions of your Canada Student Loan Agreement

2. Agreement to Repay: You promise to pay your total Outstanding Loan Balance in accordance with the Terms and Conditions of this Canada-SLA. 3. Certification: You certify that all information provided in your application for Financial Assistance and on this Certificate of Eligibility and Canada-SLA is true and complete to the

best of your knowledge. 4. Authorization: Where required by law, you authorize Canada to collect, use and disclose information related to any of your Canada Student Loan(s) or Student Grant(s), as

applicable, (i) for the purposes of carrying out the administration and enforcement of the CSFAA or CSLA, or (ii) in accordance with sections H.9(c) and H.9(d) of this Canada-SLA.

Part F - YOUR ACKNOWLEDGEMENT AND SIGNATURE By signing Part F, you freely provide your consent(s), certification(s) and ratification(s) and you agree to all the Terms and Conditions set out in this Canada-SLA. You understand that if you fail to sign this Canada-SLA, you will not receive any Financial Assistance.

Signature COPY 2 - to be given to Student

SDE-0001-03-13E-AB

Date (yyyy/mm/dd) (Version fran?aise disponible sur demande)

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