Emergency Loan Fund (ELF)

For technical issues related to the form contact internal@yugsa.ca
This form must be completed in our office with our Student Services Coordinator or other YUGSA representatives.
Applicant's Information
Name*

First NameLast Name
Student Number*
Department*
(Write department name if not in the list)
Program*

Ph.D.Masters
Year of Study*
Status*

International StudentDomestic Student
Phone Number*

Area CodePhone Number
E-Mail Address (York account preferred)*
Street Address*
Apt. #
City/Town*
Province / Territory*
Postal Code*
Supporting Documents
Select File

Cancelof
Date of Application

MonthDayYear
Date
Please do NOT submit hardcopy prints of this application or supporting documents (with the exception of the original cheques) to our office.
Original cheques must be provided to the YUGSA staff member or executive at the time of application.
This section must be carefully read and signed by the applicant
I have read, understand, and approve of the guidelines in this document and certify that on this date of the application (shown above) I borrowed the dollar amount awarded as shown in below section from the York University Graduate Students’ Association (YUGSA). This money is repayable to the York University Graduate Students’ Association in installments upon demand after the dates of individual post-dated cheques provided to YUGSA.
Type your full name and sign this agreement digitally below.*
YUGSA Staff/Executive*
OFFICE USE ONLY (Not to be filled by applicant)
Amount Awarded*
Issued Cheque Number*
Student's ELF #
General Notes
Installment Plan*
Installment 1
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 1 Notes
Installment 2
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 2 Notes
Installment 3
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 3 Notes
Installment 4
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 4 Notes
Installment 5
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 5 Notes
Installment 6
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 6 Notes
Installment 7
Due Date*

MonthDayYear
Date
Cheque Number*
Installment 7 Notes
Should be Empty:

Installment 4

Installment 7