BURSARY APPLICATION

Name ________________________________________________________________________

Law Society # ____________________________________________________________

Firm _________________________________________________________________________

Address, City __________________________________________________________________

Province __________________________ Postal Code _________________________________

Tel. # _____________________________Fax # ______________________________________

E-mail Address ________________________________________________________________

Year of Call/License __________________________________________________________

I certify that my current take-home income is below $35,000 per annum.

The above statement is true and correct to the best of my knowledge. I understand the informationcontained here will be used solely for the purpose of this application and will be held confidentialby Continuing Professional Development. I am a Law Society member/licensee in good standing.

___________________________________ ____________________________________Signature Date

NOTE:

Bursaries are valid from the date granted up to and including December 31 of the calendar year of thegrant. Bursaries do not apply to certain programs and publications. Please call (416) 947-3315 to confirmwhether a bursary is available.

Bursaries are non-transferable and must be renewed annually. Bursary discounts cannot be combinedwith other special offers or discounts. Employees of legal clinics are entitled up to 50% discounts onprogram registrations and cannot claim the bursary in addition.

Law Society of Ontario

130 Queen Street West, Attn: CPD Toronto, Ontario M5H 2N6 Telephone: (416) 947-3315

Toll-free: 1-800-668-7380 x.3315 Fax: (416) 947-5235