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    Emergency Loan Program Form

    Please fill in all fields.

    Personal Information
    First name:
    Last name:
    ID #:
    I am a(n):
    Local address:
    City:
    Postal code:
    Faculty/program:
    Telephone #:
    Email:
    Loan Information
    Have you applied for OSAP or other provincial student aid:
          If yes, Province:
    Purpose of loan:
    Amount of loan requested: $
    Repayment date:
    Source of Repayment

    State date of application:

    State employers name and start date:
    Please provide written proof from employer with your start date and hours worked per week.
    (Graduate students only):