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Ministry of Training, Colleges and Universities

Second Career

Application for Financial Assistance

(Ce formulaire est aussi disponible en français)

Preferred language of service: English French

Preferred language of correspondence: English French

SECTION A ­ IDENTIFICATION INFORMATION

Last name Permanent address Telephone no. Mailing address (if different from above)

(yyyy/mm/dd)

First name City Alternative telephone no. E-mail City Province Province

Middle initials Postal code

Postal code

S.I.N.

Date of birth:

Gender: Aboriginal Visible Minority Yes

Female

Male Person with Disability Immigrant

Please complete if you wish to self identify as a member of a designated group(s). Your response to this question is entirely voluntary and will not affect your eligibility for Second Career. This information will be used by Canada and Ontario for policy analysis and statistical purposes related to employment programs and services.

Are you a Canadian Citizen?

Yes

No

OR

are you a Permanent Resident?

No

OR Other: please explain

SECTION B ­ ELIGIBILITY

Have you been laid off on or after January 1, 2005? Yes No Are you currently employed? Yes No If attending school: full-time part-time Were you attending school full-time during the last year? Yes No Have you left school to work on a permanent basis? Yes No

If "Yes", hours per week: Job Title: Date: (yyyy/mm/dd)

Job Title:

Are you currently attending school? Yes No

Prior to applying for Second Career did you plan to return to school in the upcoming year/semester (term)? Yes No

SECTION C ­ EMPLOYMENT INSURANCE

Have you applied for or are you currently in receipt of Employment Insurance? Yes No Have you had an Employment Insurance claim that ended in the past 36 months? Yes No

Have you had an Employment Insurance claim (maternity or parental) that began within the past 60 months, and are you now re-entering the work force after having left it to care for a newborn or adopted child? Yes No

SECTION D ­ OCCUPATIONAL GOAL AND RESEARCH

What is your occupational/career goal? Please explain the reason you have chosen this as your goal.

What labour market research have you completed (e.g. employment opportunities requiring the skills you are pursuing)? Please explain.

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SECTION E ­ PROGRAM INFORMATION

What skills training program do you wish to attend?

Program Name Training Institution Name Start date (yyyy/mm/dd) Location End date (yyyy/mm/dd)

If the training you are requesting above is at a Private Career College (PCC), you are also required to research at least one publiclyassisted College of Applied Arts and Technology. Please list it here.

Program Name Training Institution Name Start date (yyyy/mm/dd) Location End date (yyyy/mm/dd)

If you require training as a prerequisite for the skills training program above (e.g. academic upgrading), please provide details below.

Program Name Training Institution/Organization Name Start date (yyyy/mm/dd) Location End date (yyyy/mm/dd)

If the training you are requesting above is at a Private Career College (PCC), you are also required to research at least one publiclyassisted College of Applied Arts and Technology. Please list it here.

Program Name Training Institution Name Start date (yyyy/mm/dd) Location End date (yyyy/mm/dd)

SECTION F ­ BUDGET WORKSHEET AND FINANCIAL INFORMATION

BUDGET WORKSHEET Part 1 ­ Monthly Gross Income (Household) Employment Income Employment Insurance Benefits Social Assistance Spousal/Child Support Self Employment Pension Income (e.g. Employer Plan) Disability Income Workplace Safety and Insurance Board (WSIB) Benefits Canada Pension Plan (CPP) Child Tax Benefits Income from Rental Property Severance/Termination Pay Any Other Sources of Income not listed above TOTAL Part 2 ­ Other Anticipated Sources of Funding Student Loans Scholarship/Bursary Any other sources of funding not listed above TOTAL Part 3 ­ Monthly Living Expenses Basic Living Expenses Rent, mortgage or room and board Food Utilities (e.g. telephone, Internet, water, heat, hydro, etc.) Other Incremental Costs Transportation & other personal supports Dependent Care ( i.e. daycare) Disability needs Other Costs (e.g. spousal/child support, loans, leases, insurance, credit card debt, property taxes, etc.) Note: The Ministry does not contribute towards these costs; however, they will be used when assessing your 0.00 application for financial assistance. $ 0.00 Amount ($) $ 0.00 $ 0.00 Amount for Self ($)

Self ($)

Other ($)

0.00

0.00

TOTAL

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$

0.00

2

Part 4 ­ Family/Household Size

Number of People In the Household

For Dependents, please list name and relationship. For dependent children under 14 years of age for whom dependent care costs are listed in Part 3 above and/or Part 5 below, please also provide the date of birth.

The number of individuals in your family is used in the calculation of financial support the Ministry may provide to you. Family size includes all dependents that you support ­ this may include a spouse, a common-law spouse, live-in dependents, and dependents who are away attending school. (Dependents should read the Notice of Collection of Personal Information.)

Part 5 ­ Funding Requested For Training Costs Associated with Training (for total period) Basic Living Costs Tuition Other Instructional Costs (such as books) Dependent Care Disability Needs Transportation Other Personal Supports (such as safety equipment, footwear and uniforms) Living Away From Home TOTAL $ 0.00 $ 0.00 $ 0.00 Total Estimated Training Costs ($) Amount of Funding Requested from the Ministry ($) Amount of Client Contribution to Training Costs ($)

SECTION G ­ CHILD OR SPOUSAL SUPPORT OBLIGATIONS

Are you required to make payments for child or spousal support under a court order made by a judge or an agreement that you signed? If you answered yes, are you behind in the payments you are required to make? If you have a support obligation, has the federal government been advised to divert your income tax refunds, GST, CPP, EI, or other federal payments to pay your support? (This would be done under the Family Orders and Agreements Enforcement Assistance Act by the Family Responsibility Office in Ontario or the support enforcement program in another province.) If you answered yes to any question above, please provide details. Yes Yes Yes No No No

Important: You may still be eligible for financial assistance under Second Career, even if you are behind in your support payments.

SECTION H ­ ATTACHED DOCUMENTATION

The following documents must be attached to your application for financial assistance to assess your eligibility and suitability for Second Career. Return to Work Action Plan or Return to Work Action Plan Summary that identifies any employment needs and the appropriateness of training as the intervention to address these needs. This document must include:

o o o o o o o

education (including highest level attained) previous participation in TCU-funded programs or services detailed work history employment barriers and needs job search efforts occupational goal and research summary of your discussion about the general financial feasibility of participating in Second Career.

A copy of the letter of acceptance from the training institution that must contain the following:

o o o o o o

the start and end date of training; the program name; the breakdown of costs; the tuition payment schedule; the number of hours of training per week; the scheduled breaks in training, if applicable.

A letter of acceptance from a private career college must also provide confirmation that the institution is registered and the program is approved, in accordance with the Private Career Colleges Act, 2005 (PCCA), or that registration/approval is not required under the PCCA. Documentation supporting your request for costs associated with training under Section F, Part 5 above (e.g. dependent care, disability needs, transportation, books, other personal supports, living away from home, etc.). The Ministry may require you to provide additional information in order to properly assess your application.

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EMPLOYMENT ASSESSMENT STATEMENT FROM CASE MANAGER:

I, (name) working for (name of organization) disagree that the training applied

have completed an assessment of this client's employment situation and agree or for is the most appropriate to assist the client in obtaining employment for the following reasons:

Signature

Date (yyyy/dd/mm)

Telephone number

X

NOTICE OF COLLECTION OF PERSONAL INFORMATION AND APPLICANT ATTESTATION:

Notice of Collection of Personal Information: Your personal information, including your Social Insurance Number, provided on your application and your Contribution Agreement, if any, with the Ministry of Training, Colleges and Universities (Ministry) and in all other communications related to the Ontario Skills Development Employment Benefit (OSDEB), including Second Career, will be used to administer and finance the OSDEB. The Ministry will collect relevant personal information directly from you and indirectly from your service provider, your employer, your training institution and Canada for these purposes. The Ministry may use the services of the Ministry of Government and Consumer Services for payment and collections matters and may use contractors and auditors to administer and finance the OSDEB. You may be contacted to request your voluntary participation in surveys and public relations campaigns related to the OSDEB. Administration includes assessing your employment and financial needs; developing your Return to Work Action Plan; assessing and verifying your application, eligibility for and any financial assistance provided by the Ministry; providing financial assistance; maintaining and auditing your file; enforcing your Contribution Agreement, if any, with the Ministry; collecting overpayments and repayments; monitoring, auditing and enforcing your service provider's compliance with its agreement with the Ministry; coordination with Canada in accordance with Ontario's obligations under the Labour Market Development Agreement between Canada and Ontario (LMDA) or the Labour Market Agreement between Canada and Ontario (LMA); planning, evaluating and monitoring the OSDEB for quality and improvements, including conducting surveys; promoting Employment Ontario programs and services, and conducting policy and statistical analysis, research and evaluation related to all aspects of Employment Ontario programs and services. The Ministry collects your personal information in accordance with the LMDA, the LMA, ss. 63 and 139 of the Employment Insurance Act, S.C. 1996, c.23, as amended, s. 76.29 of the Employment Insurance Regulations, SOR/96-332, ss. 10, 34(1) and 36(1) of the Department of Human Resources and Skills Development Act, S.C. 2005, c.34, s. 8 of the Privacy Act, R.S. 1985, c. P-21, as amended and s. 10.1 of the Financial Administration Act, R.S.O. 1990, c.F.12, as amended. For more information about the collection and use of your personal information to administer and finance the OSDEB you can contact the Manager, Employment Ontario Hotline, in writing at the Ministry of Training, Colleges and Universities, 33 Bloor Street East, 2nd Floor, Toronto, Ontario M4W 3H1 or by phone at 1 800 387-5656. Applicant Attestation: I declare that: a) I have advised my dependents and other family/household members that I have provided limited personal information about them on this application, I have showed them the Notice of Collection of Personal Information and I have obtained their consent to the disclosure and use of their personal information in connection with my application; b) The information I have provided to the Ministry on this application and supporting documentation is true, accurate and complete in every respect; c) d) e) f) If the information I have provided on this application or in any supporting documentation is untrue, inaccurate or incomplete, I acknowledge that I may be required to repay some or all of the financial assistance paid to me by the Ministry; I acknowledge that amounts payable to me under any future Contribution Agreement with the Ministry may be deducted from, or set-off against, any amounts I owe to the Government of Ontario; I have read and understood the information provided in this application package including the Notice of Collection of Personal Information above; I understand that the Ontario Skills Development Employment Benefit, including Second Career, is administered and financed by the Ministry of Training, Colleges and Universities and its contractors and auditors in conjunction with my service provider, my training institution, other ministries of the Government of Ontario and the Government of Canada and I consent to the indirect collection, use and disclosure of my personal information between the Ministry and these parties, as follows: (i) the Ministry may disclose any information contained in this application, except the voluntary self-identification as a member of a designated group above, and my Contribution Agreement, if any, with the Ministry to my service provider, my training institution, other ministries of the Government of Ontario, the Government of Canada and the Ministry's contractors and auditors and may collect relevant personal information from these parties for the sole purpose of administering and financing the Ontario Skills Development Employment Benefit, including Second Career; (ii) despite clause (i) above, the Ministry may disclose any personal information I have voluntarily provided in s. 7 of Section A of this application to Canada in accordance with the data reporting requirements under the LMDA and may use this information in depersonalized format in accordance with the data reporting requirements under the LMA; (iii) the Ministry may disclose to and collect from my employer or former employer personal information relating to my employment that is relevant to the administration and financing of the Ontario Skills Development Employment Benefit, including Second Career; and

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(iv) the Ministry may disclose personal information related to this application to the Family Responsibility Office for the purpose of verifying the amount and status of my child or spousal support obligations and may collect personal information about me from the Family Responsibility Office for the same purpose. g) If I sign a Contribution Agreement with the Ministry, the Notice of Collection of Personal Information above and the provisions of clause (f) of this Attestation form part of the Agreement. In the event of conflict between the Notice of Collection of Personal Information, or clause (f), and the Contribution Agreement, the Notice of Collection of Personal Information, or clause (f), as the case may be, will prevail. Applicant Signature Date (yyyy/dd/mm)

Applicant Name

Application received by the Ministry:

X

Date (yyyy/dd/mm)

INFORMATION SHEET

Eligibility: Eligible individuals are laid-off workers who require skills training for employment in demand occupations in Ontario. Definitions: "Laid-Off Worker" is an individual who has been laid off on or after January 1, 2005, including someone who: · is still unemployed · has taken one or more interim jobs to make ends meets but is currently unemployed. · has taken one or more interim jobs to make ends meets and is currently employed in such a job. · is on salary continuance. (Salary continuance is an alternative to providing a laid-off worker with pay in lieu of notice or severance. The employees receive their salary as per the regular pay schedule for a designated period and they may receive some or all of their benefits as well). · is on severance. (Severance is a lump sum entitlement paid to an employee upon termination of employment. Severance compensates the employee for loss of seniority and job related benefits). "Interim job to make ends meet" is a job that a laid-off individual has been compelled to take while seeking better employment. The job must have a lower wage and/or a lower skill level compared to the original layoff job. These jobs may be full-time, part-time, seasonal, or contract work. "Skills training" is a training program that provides the Second Career applicant with the skill set necessary for employment in Ontario. For EI eligible clients, skills training means any training between 6 months and 2 years in duration for NOC Level B and equivalent occupations. For non EI eligible clients, skills training means any training up to 2 years for either NOC Level B or NOC Level C and equivalent occupations. As a prerequisite for skills training, where necessary, up to one year of academic upgrading may be considered. "EI eligible" refers to an individual who meets the definition of an "insured participant" under Section 58 of the Employment Insurance (EI) Act as set out below: a) For whom an EI benefit period is established with Service Canada or whose EI benefit has ended within the previous 36 months; or (b) For whom an EI benefit period has been established in the previous 60 months and who: (i) Was paid special EI benefits under section 22 or 23 of the EI Act [maternity or parental claim] during the benefit period; (ii) Subsequently withdrew from active participation in the labour force to care for one or more of their new-born children or one or more children placed with them for the purpose of adoption; and (iii) Is seeking to re-enter the labour force. "Non EI eligible" refers to an individual who does not meet the definition of an "insured participant" as set out above. "Demand Occupation" is an occupation for which there is a demonstrated need in Ontario. General Information: You must use this application form to make your request for assistance under Second Career. The date your completed application is received by the Ministry is when you are considered to have requested assistance for the purpose of determining your eligibility. Before the Ministry can assess an application, you will need to receive an employment assessment from and develop a Return to Work Action Plan (RTWAP) with a case manager at an employment and training service provider (service provider). Please contact the Employment Ontario hotline by phone at 1-800 387-5656 or visit the Employment Ontario website at: http://www.ontario.ca/employmentontario for information on where you can find this service in your area. An application for Second Career must be approved by the Ministry before you start training. It is important to note that any costs incurred prior to receiving approval from the Ministry are not eligible for reimbursement. If you have a job and are contemplating quitting it in order to attend a program of training, you should not do so without consulting the Ministry beforehand. In the event an applicant is not eligible for Second Career, the information provided on this application may be used to determine eligibility for the OSDEB. Income Tax: Financial assistance paid to Second Career participants is included as income for tax purposes. Tax will be deducted at source from financial assistance payable to participants with the exception of dependent care costs and tuition, including tuition for Adult Basic Education, which is no longer subject to tax. You may be able to claim the tuition tax credit for tuition that you pay in order to take a program if the training institution you attend is eligible to issue tuition receipts for purposes of the tuition tax credit. You should check with the Canada Revenue Agency or any potential training institution to make sure it is eligible to issue these receipts (T2202). If the institution is not eligible, you should know that you will not be able to reduce the income tax you have to pay on the money you receive for tuition costs by means of the tuition tax credit.

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