16-19 BURSARY APPLICATION FORM (2018/19)

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1 16-19 BURSARY APPLICATION FORM (2018/19) This Section should be completed by students who have a need for financial support whilst studying at One College please read the questions carefully before answering. Start date at One (1) STUDENT DETAILS Forename(s) Surname/Family Name Address Postcode Date of Birth Home telephone number Mobile number (2) ELIGIBILTY part 1 Tick the boxes that apply to you I have been ordinarily resident in the UK for 3 years from my start date at Suffolk One. I am in receipt of an Education, Health and Care Plan ELIGIBILITY part 2 Tick the boxes that apply to you I live with my parent(s) carer (s) Go to section 3) I am a young person in care (including foster care) and enclose a letter from the local authority confirming my looked after status. (Go to Section 4) Receive benefits in the applicant name only

2 (3) DISCRETIONARY BURSARY - Income details evidence of household income required photocopies only. Employed Income please provide a P60 or last 3 months salary slips Self Employed Accounts showing annual income Child Benefit/Working Tax Credit/Child Tax Credit Please provide form TC602 for the year 2017/18 Confirmation letter from DWP required if the personal circumstances are unchanged and you are already in receipt of the Bursary. Income support or Universal Credit/Employment Support Allowance (ESA) Income Based Jobseekers Allowance/ Pension Credit Any other income Parent(s)/Carers address Parent(s)/Carers mobile number (4) VULNERABLE BURSARY (Please bring evidence of your status when you enrol at One) - photocopies only I am a young person in care (including foster care) or care leaver and enclose a letter from the local authority confirming my looked after status. I am in receipt of Employment & Support allowance (ESA) or Universal Credit and Disability Living Allowance (DLA) or a Personal Independence Payment (PP) and enclose appropriate proof of benefit letters. I am in receipt of Income Support or a Universal Credit payment and live independently and am financially supporting myself and anyone who is dependent on me, such as a child or a partner and enclose proof of benefit letters

3 (5) Please complete bank account details Bank Account for BACS payments (Full name of account holder as name appears on cash/debit card or statement) Name of Bank / Building Society Branch location SORT CODE ACCOUNT NUMBER ROLL NUMBER (Building Society account) Please provide a photocopy of ONE of the following if you wish to provide verification evidence: - Either a Bank paying in slip or Debit card If you do not wish to show evidence, we do not take responsibility if the details are recorded incorrectly in this form. Second payments will not be paid due to incorrect details. Please indicate your travel arrangements to Suffolk One Stowmarket One Bus Felixstowe One Bus SCC Transport Train Other What is the cost of your transport per term?.. Please indicate if you are eligible for free school meals - yes no Subjects you have enrolled for: -.. Please indicate additional costs associated with your course:-.

4 Additional Information to Support Your Application Please tell us of any circumstantial changes that apply e.g. redundancy, long-term illness, benefits change etc. (Do not forget to supply photocopied supporting evidence). Attendance Your attendance will be monitored on a termly basis and should be a minimum of 85%. All absences must be authorised and be notified to the college immediately and supported by a letter from your parent/carer. Awards will be made as follows based on the following attendance levels: Attendance Thresholds Payment 100% to 85% 100% 75% to 84% 75% 50% to 74% 50% 0% to 49% 0% If there are mitigating circumstances for higher attendance levels these will be dealt with on an individual basis.

5 DECLARATION AND CONDITIONS Bursary Fund - Terms & Conditions Suffolk One is committed to supporting all students in maximising their potential and achieving their aspirations. In particular the College recognises that some students face financial challenges and accordingly has developed the Bursary Fund, in line with Government guidelines. In return for awards from this fund students are required to commit to their college life. In particular and as stated in the information accompanying the application form the College regards attendance as a key factor in student s chances of succeeding. The College monitors student attendance on a regular basis and has set a benchmark of 85% attendance as the minimum a student should attain, and your award is dependent on it. We recognise that there may be circumstances in any one week that are exceptional, but any prolonged or repeated absence will result in the award being reconsidered. Should your attendance fall below 85% during the academic year further termly payments may be affected or withdrawn. If your attendance continues to be below this figure your award may be withdrawn altogether and the College may seek to recover any amounts already paid. Privacy Notice The information that you provide on this form will be used to assess your eligibility for a Bursary and make payments. This information may be shared with the Education Skills Funding Agency for England. All documentation associated with Bursary applications will be retained and stored for 6 years. When this period has lapsed all personal data will be destroyed securely. Suffolk One College is registered as a Data Controller. Declaration If you give false or incomplete information, you may be prosecuted. I have read and understood these questions and the Privacy Notice above and declare that the information given on this form is correct and complete to the best of my knowledge and belief. I understand that: If I leave Suffolk One College I will not be eligible to receive further payments and may need to repay a proportion, or in exceptional cases all of the money paid to me as part of this scheme. I am not allowed to receive award payments at the same time as any other government training or learning allowance (this does not include Income Support). The information I have given may be shared with the Education Skills Funding Agency, for the purpose of checking applications and/or the prevention of fraud. I have read and agree to the Terms and Conditions of the Award Scheme above. I must notify College of any changes in my circumstances and details. I will not normally be expected to repay an award, but my entitlement to further payments may be affected. Student Signature Parent(s) signature Date Date By signing or submitting this form online you are agreeing to all of the above statements & conditions. Please tick the box to confirm you have uploaded or provided all appropriate evidence.