1. (A) If your situation has changed, complete pages 1 and 2, and submit only the pages for the changes you require. If you need to submit Schedules 1, 2, 3, or 4, they are posted separately on studentaid.alberta.ca.
φ
Change in Personal Information (legal name, marital status)φ
If your marital status has changed from Single to Married/Common Law, also complete Schedule 2φ
Change in Number of Dependent Childrenφ
Change in Full-Time or Part-Time Study Informationφ
If you are Concurrently Enrolled, also complete Schedule 3 (Concurrently Enrolled means you are simultaneously attending more than one school on a part-time basis.)φ
Change in Monthly Cost or Resource Informationφ
Change in Parental Personal and Financial Information – complete Schedule 1φ
Change in Spouse/Partner Information – complete Schedule 2φ
I am now indicating that I have a Permanent Disability – complete Schedule 4(B) If your situation has not changed but you did not receive enough money to cover expenses, or you did not receive any funding, and you want your Application reassessed, complete pages 1 and 2 and provide an explanation for your request in the space provided.
(C) If you have been reassessed and disagree with the result, complete pages 1 and 2 and provide an explanation for your request in the space provided.
2. Submit your completed pages to Student Aid Alberta. Remember to include: • Page A showing the changes you have selected
• pages 1 and 2 with your personal information and mandatory funding request question • only the pages for each change you require
• acceptable supporting documentation as described on each page
Page A
Send documents electronically* 1. Visit studentaid.alberta.ca 2. Sign in via SFS Login
3. Submit securely using e-Document Upload
*For assistance: e-Doc Upload FAQ
Mailing Address STUDENT AID ALBERTA PO BOX 28000 STN MAIN EDMONTON AB T5J 4R4
Information
Instructions to Complete the Request for Reconsideration Form (Level 1)
Upload or Mail Your Form
After you have submitted an Application for Financial Assistance, you may find that your situation has changed or you want to have your Application reconsidered. The following are examples of when you may need to submit a Request for Reconsideration Form (Level 1): • You did not receive enough money to cover expenses, or you did not receive any funding,
and you want your Application reconsidered • Your living and/or education costs have changed
• Your financial circumstances or those of your spouse/partner have changed • Your academic, family or personal situation has changed
Note: Your application may also be reconsidered if your post-secondary institution submits a change in your information, for example, a change of study start and end dates.
Deadline: A Request for Reconsideration must be received by Student Aid Alberta at least 30 days prior to the period of study end date indicated on your current application.
Processing time: It may take up to 40 days from the date of receipt for Student Aid Alberta to process your request.
Request for Reconsideration Form (Level 1)
Do you require additional funding for your current period of study?
Funding Request (mandatory)
Request for Reconsideration
Form (Level 1) 2015/2016
15/16 RR1
Applicant's Personal Information
Reason for Requesting Additional Funding
Social Insurance Number Alberta Student Number (mandatory)(obtained from Alberta Transcript of High School Achievement)
Award Reference Number
(Refer to your Student Award Letter)
$ Mobile Number (format: 999-999-9999) to receive text messages
Email Address
Telephone Number (format: 999-999-9999)
City/Town Prov/State Country Postal/Zip Code
Street Address Apartment or Box Number
First Name (current full legal name)
Last Name (current full legal name) Middle Initial
07/16 APP-TYPE IA APP-YEAR 2015/2016 APP-FORM-A For Office Use Only App ID
Page 1
If yes, provide the reasons for your request for more funding in the space provided. If yes:
φ
I am requesting a specific amount ORφ
I want the maximum amount I am eligible to receiveφ
Yesφ
NoInnovation and Advanced Education is collecting this personal information under the authority of sections 33(a) and (c) of the Freedom of Information and Protection of Privacy Act (Alberta) to determine and verify the Applicant’s eligibility for financial assistance, to administer (including research, statistical analysis and evaluations) and to enforce student financial assistance programs in accordance with the Student Financial Assistance Act (Alberta), the Canada Student Loans Act and the Canada Student Financial Assistance Act, each as may be amended from time to time. The use and disclosure of your personal information is managed in accordance with the Freedom of Information and Protection of Privacy Act (Alberta). If you have any questions about the collection, use or disclosure of this information, call the Student Aid Alberta Service Centre toll free at 1-855-606-2096 from anywhere in North America. You can also mail your questions to Student Aid Alberta, Privacy Officer, PO Box 28000 Stn Main, Edmonton AB T5J 4R4.
Page 2
Applicant Declaration
This Request for Reconsideration Form (Level 1) for Post-Secondary Studies, including any Schedules and documentation (“Request for Reconsideration Form (Level 1)”), supplements, amends, and forms part of the Application for Financial Assistance that I previously submitted to the Minister of Innovation and Advanced Education (“Minister”) pursuant to the Student Financial Assistance Act (Alberta), the Canada Student Loans Act and the Canada Student Financial Assistance Act (“Original Application”).
By submitting this Request for Reconsideration Form (Level 1), I declare that all information provided in this Request for Reconsideration Form (Level 1) is true and complete, and I understand that the information that I provide is subject to review and assessment by the Minister in accordance with the Student Financial Assistance Act (Alberta), the Canada Student Loans Act and the Canada Student Financial Assistance Act. I understand that this Request for Reconsideration Form (Level 1) supplements, amends and forms part of my Original Application.
I acknowledge that the declarations I provided in the Original Application and the declarations and consents I provided in the Master Student Financial Assistance Agreement – Alberta and the Master Student Financial Assistance Agreement – Canada (see the Completing your Master Student Financial Assistance Agreement information sheet at studentaid.alberta.ca) also apply to this Request for Reconsideration Form (Level 1) and to the personal information that I have provided in this form.
I understand that if I make a false or misleading statement in this Request for Reconsideration Form (Level 1), fail to disclose
information or fail to notify the Minister of any changes to the information provided in this Request for Reconsideration Form (Level 1), it may result in one or more of the following: I may be denied financial assistance, be required to immediately repay all financial assistance received, or be subject to criminal prosecution.
Comments/Additional Information
Change In Personal Information
Legal Name Change
Change in Marital Status
Documentation Required
Previous Last Name
Previous First Name Middle Initial
If your name has changed, complete this section with your previous name(s) and attach a copy of one of the appropriate documents listed below.
Day Month Year
Date Marital Status Changed:
• If your marital status has changed to married or common law, your spouse/partner must complete and sign a Schedule 2. • If your spouse’s/partner’s information has changed, they must provide the revised information on Schedule 2 and explain the
changes in the space provided.
Marital Status Changed to:
φ
Separated/Divorced/Widowedφ
Marriedφ
Common LawCircumstance Acceptable Documentation (provide copies – do not send originals)
Legal Name Change • Legal Name Change document
• Marriage certificate • Divorce/separation papers
• Driver’s license • Passport
Change in Marital Status • Marriage certificate
• Divorce papers
• Letter stating date of separation
• Driver’s license • Passport
Consideration may be given for child care/daycare costs exceeding $724/month/child with appropriate documentation. Monthly Child Care Cost (after subsidy)
Day Month Year
Date Changed:
Last Name First Name Birthdate (day/month/year) Relationship to you
$
Comments/Additional Information
Circumstance Acceptable Documentation (provide copies – do not send originals) Dependent Children over the age of 18 • If attending regular high school, provide the details in the space above
• If permanently disabled, provide medical documentation showing your child requires special daily care
Legal Guardianship • Legal Guardianship papers verifying custody of the additional dependent(s) you are now claiming
Additional Child Care Costs • Current receipt or statement from your child care provider (after subsidy) OR
• Current receipt or statement from your child care provider showing amount paid after subsidy
Change in Dependent Children Information
Monthly Child Care Costs (after subsidy)
Documentation Required
If the number of dependent children has changed since you last applied, complete this section. Dependent children means those children who are living with you and for whom you and/or your spouse/partner are legally responsible. Student Aid Alberta will consider children over the age of 18 if they are permanently disabled or attending regular high school. If the child you are listing is not your son or daughter (e.g. niece, nephew, grandchild) or if you have adopted a child, you must provide documentation confirming your Legal Guardianship (see below).
Complete this section if you are changing programs and/or study start and end dates. You must attach documentation from your school verifying the changes or your request will not be considered (see below).
There are some situations when you need to submit a new application instead of a Request for Reconsideration Form (Level 1). If the situation(s) below applies to you, then submit a new Application for Financial Assistance:
• you are changing schools/campuses
• your new start date is more than 30 days past your original start date
• there is a break of 30 days or more between your school terms
Program Outcome
φ
Certificateφ
Diplomaφ
Degreeφ
Degree – Mastersφ
Degree – Doctoralφ
Journeyman Certificate StartDay Month Year
Dates I will attend school (these dates cannot exceed 12 months)
End
Day Month Year
Circumstance Acceptable Documentation (provide copies – do not send originals) Change in Full-time
or Part-time study information
• Official documentation from your school indicating your program, specialization, program outcome, program term dates, and a breakdown of your tuition, mandatory fees, and books/supplies.
Extension of study end dates
• Medical documentation AND confirmation from your school confirming that your study period end date has been extended. The maximum extension permitted for medical reasons is one (1) month. Educational Costs for Study Period
Tuition $
Mandatory Fees (does not include housing/residence costs) $
Books/Supplies/Instruments $
Computer Costs $
Program
Program Specialization/Major
Change In Full-Time or Part-Time Studies Information
Comments/Additional Information
Documentation Required
Will you complete your program of study and receive your
post-secondary certificate, diploma, or degree by the session end date?
φ
Yesφ
NoAre you enrolled in a correspondence/e-learning/distance study program?
φ
Yesφ
No What year of this program will you be in? (check one)φ
1st year or lessφ
2nd yearφ
3rd yearφ
4th or 5th yearLength of your program of studies (check one)
Monthly Resources While in School Monthly Amount Date Income Changed, if applicable (day/month)
Wages/Salary (net income) $
Assistantships after deductions $
Stipends $
RESP and Voluntary Contributions from Parents $
Alimony and/or Child Support you receive $
Employment Insurance (EI Benefits) $
Assured Income for the Severely Handicapped (AISH) $
Workers’ Compensation Benefits $
Aboriginal Affairs and Northern Development Canada/Band Funds $ Other Income (pensions, rental property, business) $ Total Monthly Resources $
Your application has already been assessed for standard living costs (see studentaid.alberta.ca). If you are requesting additional funding due to high costs, you must provide the appropriate documentation to be considered (see pages 2 and 3).
Monthly Costs While in School Monthly Amount Date Costs Changed, if applicable (day/month)
Rent/Mortgage $
Utilities (power, water, phone, etc.) $
Transportation (to get to and from school) $
Medical (costs not covered by insurance) $
Child Support Payments you make $
Other (provide explanation on next page) $
Total Monthly Costs $
Change in Costs and Resources - page 1
Complete only the information that needs to be reviewed.
Resources
Costs
While attending school, I will be living with:
φ
Parentsφ
OtherComments/Additional Information
Other Resources Available to Me
Savings you will have when you start school (include TFSAs) $
Assets (e.g. bonds, stocks, GICs, etc.) $
Registered Retirement Savings Plans (RRSPs) $
Other Resources List: $
Scholarships (e.g. Rutherford, Athletic, Louise McKinney, other) $
Change in Costs and Resources - page 2
Circumstance Acceptable Documentation (provide copies – do not send originals) Requesting Tuition and Books Only
If your resources exceed the costs Student Aid Alberta considers, you can request to receive funding to cover the costs of your tuition and books.
• Submit a letter requesting tuition and books, or • Call the Student Aid Alberta Service Centre
Rent/Mortgage and Utilities
Consideration may be given for rent or mortgage costs, property taxes, condo fees, and standard utility payments.
• Copies of rent receipts or lease agreements • Mortgage agreements
• Copies of basic utility bills (e.g. power, natural gas, water, sewer, garbage, phone) Cable, satellite, and internet are not considered basic utilities.
Child Support/Alimony Payments made by you or your spouse/partner Consideration may be given if you pay child or spousal/partner support.
• Proof of payment for the last four months, AND
• Maintenance Enforcement report, copy of court order, or a letter signed by your ex-spouse/partner that confirms the amount you pay monthly
Transportation
Additional travel costs may be considered for students when it is more economical to commute to school rather than relocate.
• Provide the distance it takes to travel from your residence to your school
• Receipts showing your basic vehicle insurance costs (PL/PD only) Medical/Dental/Optical
Medical expenses that are not covered through Alberta Health Care or your student health plan may be considered.
• Receipts and associated medical documentation.
Aboriginal Affairs and Northern Development Canada/Band Funds
• Provide confirmation from the band stating the monthly amount and whether the band will cover tuition, fees, and books.
Documentation Required for Other Exceptional Circumstances
Circumstance Acceptable Documentation (provide copies – do not send originals) Additional Tuition, Fees, and Books
If your actual costs are higher than what your educational institution has provided to Student Aid Alberta, consideration can be made for your high tuition.
• Provide official documentation from your educational institution confirming your actual education costs.
Second Residence
If you are living apart from your spouse/partner to attend school.
• Copies of rent receipts or lease agreements • Mortgage agreements
• Copies of basic utility bills (e.g. power, natural gas, water, sewer, garbage, phone) Cable, satellite, and internet are not considered basic utilities.
Student Loan Payments made by your spouse/partner
If your spouse/partner is currently repaying a government student loan, the cost of those payments may be considered.
• Provide a statement from the service provider confirming the amount of the monthly payments.
Other
Other exceptional expenses may be considered.
• Provide supporting documentation and/or receipts.
