Student Hardship Funds Eligibility Questionnaire 2017/2018

Transcription

1 Student Hardship Funds Eligibility Questionnaire 2017/2018 Please indicate which fund/s you are applying to: a) Access to Learning Fund* b) International Students Emergency Fund c) International Students Childcare Fees Remission Scheme* d) Part-time Undergraduate Childcare Grant Scheme (UK Home students only)* *Applicants to the International Students Childcare Fees Remission Scheme, Part-time Undergraduate Childcare Grant Scheme or students applying to ALF for help with childcare costs will need to complete a Childcare Information Form for each child which can be downloaded from For details about how your application will be assessed, we recommend that you read the Guidance Notes at before you submit your application. Please return your completed form along with ALL required evidence to: Student Funding, Senate House, University of Warwick, Coventry, CV4 7AL. (Please ensure that you include the correct postage) Should you have any queries, please telephone or studentfunding@warwick.ac.uk. Section A- Personal Details Name:... University ID Number: Date of Birth:... /... /... Personal Status (please tick all that apply to you):- Single Living with partner* With child dependants Living with parents *If you are living with your partner you need to complete a Partner Information Form Full names and ages of child dependants: Child s Name Age Lives with you full-time or part-time (Please circle) Is this child in registered childcare?* (Please tick) *Please provide a Childcare Information Form for every child who is in registered childcare. If your child goes to more than one childcare setting please provide a form for each provider.

2 Have you applied for an award from University Hardship Funds before, either at Warwick or a previous University? Yes No If yes, please give details and dates: How do you travel to and from University at the beginning and end of term? Please state destination and cheapest return cost using a railcard/ coach card (Undergraduate and first year MBChB students only): Do you have a disability or health related problem? Please give details and state any extra costs this incurs that are not covered by Disabled Students Allowances Please provide a statement to support your application for an award from the Hardship Funds:. (Please continue on a separate sheet if necessary)

3 Section B- Income for the academic year Please tick below to indicate which income you receive. For every item you have ticked you need to provide evidence which clearly shows your name, the amount received and the date. Evidence needs to be applicable to the academic year. Refer to the ALF Checklist for further details about the evidence required. *Please note for earnings we need wage slips from the start of the academic year. Student Maintenance Loan Maintenance Grant Special Support Grant Parents Learning Allowance Adult Dependants Grant Childcare Grant Student Finance England Postgraduate Loan NHS/ Social Work Bursary: ITT Training Bursary: Scholarships/ Bursaries (other than Warwick USB/ MSP/ Lloyds/ Nexen/Warwick Scholars) Professional and Career Development Loan/ Graduate Loan Funding Council Award/s Housing Benefit Job-seekers Allowance Income Support Universal Credit Employment and Support Allowance Other benefits (not including PIP or DLA) Child Tax Credits Working Tax Credits Child Maintenance Net Earnings* (Partners of students/ Postgraduate students/ Part-time Undergraduate students only) Income from any other source e.g. parental contribution, pensions, savings, tenants, sponsors, other loans.

4 Section C- Your Current Financial Situation Please state the account details, overdraft facilities, and current balances of all bank accounts you have at the time of application and details of any outstanding debts. You will need to provide bank accounts for the last 3 months (up to the day before you hand in your application) for every account held and your most recent statement for any debts. Bank Accounts: Type of Account Bank Latest Balance Overdraft Limit Current Account 1 Current Account 2 Savings/ISA 1 Savings/ISA 2 Other (please indicate type) Other (please indicate type) Debts: Credit Card 1 Credit Card 2 Store Card 1 Store Card 2 Type of Debt Outstanding Loans (excluding student loans) Creditor Outstanding Balance Minimum Monthly Repayment (if repaying) Other (please indicate type) Other (please indicate type) Other (please indicate type) Other (please indicate type)

5 Section D- Weekly Expenditure Accommodation Costs Please provide evidence of your accommodation cost which clearly shows your name, the date and how much rent or mortgage you pay. If you have a mortgage please also provide a copy of your most recent building insurance document. Is your term-time address (tick as appropriate):- On campus Warwick Off-Campus Housing Association/ Council Property Privately Rented Mortgaged Property Parental Home How do you pay for your accommodation? Rent Mortgage Rent to parents Housing Benefit If you live in shared accommodation: how many people, excluding yourself, do you share with?. Core Living Expenses and Course Costs Core living costs for items such as food, toiletries, laundry, clothing, utilities, telephone, TV licence, contents insurance and entertainment and leisure for all members of your household will be based on expenditure levels that are recommended by the National Association of Student Money Advisers and the National Union of Students. Course costs are set by the Student Funding department. If you have other costs not including those listed in bold above please list them below: Children s School Meals Travel Costs (during term time)

6 Please remember to bring your University ID card with you to your appointment Payment of your award Hardship Fund awards can be credited, at your request, to your University account for accommodation, repayment of emergency loans and University Nursery charges. Alternatively, funds will be paid directly into your bank account on receipt of your bank details. If your Hardship Fund application is successful, we will inform you of any action you need to take in order for your award to be processed. Section E- Declaration I have read and understood the Guidance Notes relevant to my application I confirm that I fulfil the criteria described in the Guidance Notes. I also confirm that the information I have provided is, to the best of my knowledge, complete and correct. I understand that this information may be verified and that any significant discrepancy may result in my claim being delayed or cancelled. The University of Warwick processes all personal data in accordance with the Data Protection Act By completing this form I agree that the University may use my data for the purpose of processing my application, including transferring such data to third parties where it is required to process my application. Signed:... Date:... Fraudulent claims will be treated as an extremely serious offence. Successful applicants to the University s Hardship Funds will be required to report subsequent changes in their financial circumstances to the Student Funding Office. Details of the Hardship Funds Appeals Procedure can be downloaded from our website: