Department of Leadership, Higher and Adult Education

To be completed by the Applicant – OPEN ONLY TO LHAE DOCTORAL STUDENTS IN YEARS 5 & 6
Last Name: / First Name:
Home Address:
Phone Number: / U of T Email:
Student Number: / Program: /  Canadian Citizen or Permanent Resident
 Student Visa
Did you interrupt your studies at any time to take a leave?  No: Yes, Date: ______
I will begin/began my first non funded year on : ______(month/year)
Did you receive a DCA in the past?  No:  Yes, Date: ______Amount: $ ______
List any financial support you will receive in the 2016-2017 academic year. If you have confirmation that any award applications were successful, please list them here. Include fellowships, scholarships, grants, externals awards, GA, RA or other stipends, TA, TEPA, including paid work outside of the university, e.g., substitute teaching, etc.
1.______$______
2.______$______/ 3.______$______
4.______$______/ 5.______$______
6.______$______
List any financial support you have applied for (scholarships, awards, GA, TA, TEPA) that, if successful, you would receive in the 2016-2017 academic year. (I.e. you have not received confirmation yet).
1.______$______
2.______$______/ 3.______$______
4.______$______/ 5.______$______
6.______$______
PLEASE ANSWER THE FOLLOWING QUESTIONS. DO NOT ATTACH ANY MATERIALS OTHER THAN THOSE REQUESTED.
  1. Describe your progress and accomplishments to date (i.e. where you are in completing your program – field work, data analysis, writing draft of thesis, etc.)
  1. Describe the amount of work remaining to be done. Include timeline and expected date of completion.
  1. Provide reasons why you have been unable to complete the above work within the timelines of the funding period provided to students in your graduate unit.
  1. If you received the Doctoral Completion Award previously, please describe your progress since receiving the award.

Applicant’s Signature: / Date: /  CV attached (3 pages maximum)
 ROSI Printout of Transcript
Doctoral Progress Form
Financial Need Assessment Form

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