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2019-2020 Attestation of Pregnancy
1028
Form to be used by the student to inform Aide financière aux études that she is at least 20 weeks pregnant.
Once the child is born, remember to send us a copy of the birth certificate.

Section 1 – Student Information
Last name

Permanent code assigned by the Ministère

First name

Date of birth
Y

Social insurance number
M

D

Section 2 – Student Declaration
I hereby declare on this date to be at least 20 weeks pregnant and ask to benefit from the measure applying to pregnant women in the processing of my
application for financial assistance for the current award year or the application to postpone the repayment of a student loan debt during a temporary
interruption of studies. I certify that the information provided is accurate and complete and authorize the person mentioned on this form to submit the
following information about me or my health to Aide financière aux études.
Date

Y

M

D

Student’s signature X

Section 3 – Authorized Person’s