Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Ontario Graduate Scholarship Application Form Part A: Student Profile
*All applicants to the Ontario Graduate Scholarship must complete Part A. *Please note the applicable OGS application deadlines as below: • If you are requesting funding for a master’s program: December 1, 2017 • If you are requesting funding for a doctoral level program and your proposed study falls under the CIHR mandate: September 29, 2017 • If you are requesting funding for a doctoral level program and your proposed study falls under the NSERC mandate: October 13, 2017 • If you are requesting funding for a doctoral level program and your proposed study falls under the SSHRC mandate: October 17, 2017 * Please submit your application to your graduate program.
Student Information Family name:
First name:
Middle name(s): Citizenship Status:
Canadian/permanent resident,
international student,
other
Aboriginal status (optional): I am an Aboriginal student and identify as such per my institution’s Aboriginal self-identification policy. This assertion means that I identify as a member of the First Peoples of Canada meaning, in general terms, First Nation, Metis, Inuit, Indigenous, Aboriginal or specifically by my home community or my Nation. Sex/Gender:
male,
female,
other (please specify)
Address:
Telephone:
Email:
York Student ID: Are you currently enrolled at York University? Yes No
SIN number:
Proposed level of study: MA1, MA2, PhD1,
PhD2,
If yes, current level of study: MA1, PhD3,
MA2,
PhD1,
PhD2,
PhD3,
Undergradate
PhD4,
Proposed field of study: Choose one whose mandate covers your subject matter (CIHR, SSHRC, NSERC). For details, - please select onesee the Tri-Council guidelines. Proposed program of study: Number of terms for which funding is requested (2–3 terms): Expected date to begin proposed studies:
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Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Ontario Scholarship Application Form Other Awards Are you applying to any one of the following awards for the 2018–2019 academic year? Canada Graduate Scholarships — Master’s (CGSM) SSHRC Fellowships and CGS Doctoral Awards (DF/CGSD) CIHR Doctoral Foreign Study Awards and CGS Doctoral Awards (DFSA/CGSD) NSERC Postgraduate Scholarships and CGS Doctoral Awards (PGSD/CGSD) No I am not applying to any of the above awards for the 2018–2019 academic year. If this applies to you, please complete Part B of this form. One of the eligibility requirements for OGS is that you must not have exceeded the lifetime maximum of 6 years of government–funded student awards. Please indicate if you have ever been in receipt of any of the following awards: Social Sciences and Humanities Research Council (SSHRC)
Yes No
Number of years you received this award:
Natural Sciences and Engineering Research Council (NSERC)
Yes No
Number of years you received this award:
Canadian Institute of Health Research (CIHR)
Yes No
Number of years you received this award:
Ontario Graduate Scholarship (OGS)
Yes No
Number of years you received this award:
Queen Elizabeth II Graduate Scholarship in Science and Technology (QEIIGSST)
Yes No
Number of years you received this award:
Ontario Trillium Scholarships (OTS)
Yes No
Number of years you received this award:
Vanier Canada Graduate Scholarship (Vanier CGS)
Yes No
Number of years you received this award:
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Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Notice, consents, declaration, and signature of applicant Applicant’s consent to the indirect collection and disclosure of personal information • I agree that York University may, without limitation, collect, use and disclose personal information about me that is relevant to the administration and financing of OGS with: its authorized financial administration agents and auditors; my academic references; SSHRC; NSERC; CIHR; bodies identified on this application form and other bodies, including government bodies within and outside Canada that administer scholarships for graduate study or student loans; the Ministry’s contractors, auditors and third party administrators; Ministry of Government Services and collection agencies it operates or retains; and consumer reporting agencies. • I agree that York University can, without limitation collect, use and disclose personal information about me that is relevant to the consideration of my OGS application and its report to the Minister with respect to the granting of the OGS with: the Ministry, my academic references and the selection panel it appoints to assess my application. Applicant’s Declaration • I have given complete and true information on this application form and in the required supporting documentation. • I understand that I am responsible for providing all required supporting documentation as indicated on my application or as directed by the Ministry or my eligible Ontario institution in respect of my eligibility for an OGS. • I understand that information I provide will be verified and audited and the Ministry may also conduct inspections and investigations. • 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 will promptly notify York University in writing of any changes to the information that I have provided and of any changes to my eligibility for an OGS, including ceasing to be enrolled in an eligible program at an eligible Ontario institution; receiving an NSERC, SSHRC, CIHR, Vanier, Trillium or QEIII-OGSST or becoming employed for more than an average of 10 hours per week. • I understand that any change to the information I provide and any change resulting from verification and audit will result in a reassessment. • I understand that if my application is reassessed, it may affect my eligibility and the amount of my OGS and, if required by the Minister I will promptly repay all or part of my OGS. • 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 and that my declaration is complete and true. I understand that any fraudulent or misleading statement may result in proceedings for academic misconduct. Applicant signature
Date: (mm/dd/yyyy)
Applicant’s consent and signature to the release of personal information (OPTIONAL) (For Ministry use only - Will not be shared with OGS Selection Board or Selection Panels) I hereby authorize the Ministry to release to the person(s) named on my 2015-2016 OGS application any information contained in my OGS file for the 2015-2016 academic year and all prior academic years. This consent is valid during my 2015-2016 academic year only. I may withdraw this consent prior to the end of the 2015-2016 academic year by writing to the Director, Student Financial Assistance Branch, Ministry of Training, Colleges and Universities, PO Box 4500, Thunder Bay, ON P7B 6G9. Applicant signature
Date: (mm/dd/yyyy)
Privacy: Personal information in connection with this form is collected under the authority of The York University Act, 1965 and will be used for educational, administrative and statistical purposes. If you have any questions about the collection, use and disclosure of personal information by York University, please contact: Faculty of Graduate Studies, 230 York Lanes, (416) 736-2100 x 55521. Page 3 of 11
Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Part B: Application Information * Complete Part B if you are not applying to any of the federal-level awards (see the section of “Other awards for 2018-2019” in Part A). If you are applying to any one of the federal-level awards identified above, do not complete Part B. You will be automatically considered for the OGS. Applicant Information Last name:
First name:
Middle names: SISID (if applicable):
Date of birth:
Application Title:
Summary of Proposal Plan of Study (up to 300 words)
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Ontario Graduate Scholarship Form, 09/2017
Proposed Research or Plan of Study If you are requesting funding for a doctoral level program and your proposed study falls under the SSHRC mandate, your proposed plan should be a maximum of 2 pages (excluding references). For all others, it should not exceed 1 page (excluding references).
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Ontario Graduate Scholarship Form, 09/2017
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Ontario Graduate Scholarship Form, 09/2017
References (1 page maximum)
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Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Student Profile Education (from most recent) Start date Degree status:
End date (or expected end date) completed,
in progress,
incomplete
Degree name
Program
Institution
Start date
End date
Degree status:
completed,
in progress,
incomplete
Degree name
Program
Institution
Start date
End date
Degree status:
completed,
in progress,
incomplete
Degree name
Program
Institution
Start date
End date
Degree status:
completed,
in progress,
incomplete
Degree name
Program
Institution
Start date
End date
Degree status:
completed,
in progress,
incomplete
Degree name
Program
Institution
Start date
End date
Degree status: Program
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completed,
in progress,
incomplete
Degree name Institution
Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Awards and Recognitions (from most recent) Year(s) Awarded
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Name of Scholarship, Award, Prize, etc.
Funder
Amount (if applicable)
Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Employment Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
Start date (Year/Month)
Position
End date (Year/Month)
Organization
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Ontario Graduate Scholarship Form, 09/2017
Office of the Dean York University
230 York Lanes – 4700 Keele Street Toronto, ON, Canada M3J 1P3
Tel: (416) 736-5521 gradstudies.yorku.ca/
Research Contributions (such as publications, presentations, and other relevant activities)
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Ontario Graduate Scholarship Form, 09/2017
