Suffolk New College 2017/ Bursary Application

Transcription

1 Date Received: Suffolk New College 2017/ Bursary Application For office use only: 19+ Discretionary Bursary Section 1 - Personal Details Student Number Bursary Number (office use only) Forename(s) Surname Address (including postcode) Date of Birth Age on 31st Aug Home Tel. No. Mobile Tel. No. address: Who do you live with? (please tick all that apply) Parents / Guardians Partner Live Alone Other (please specify) Residential Status: UK / EU / EEA Citizen Discretionary or indefinite leave to remain Refugee or humanitarian protection Asylum seeker or child of asylum seeker Course Information: Course Code Course Title Full Time Course >= 540 Hours of Study Part Time Course < 540 Hours of Study ALS FCM ALS RLS FCM Info Need 1st QLS 2nd QLS

2 Section 2 - Priority Groups Are you (or your parents / carers) in receipt of the following benefits: (please tick all that apply) Income Support Income Related Job-Seekers Allowance - NB: Not contribution based Income Related Employment & Support Allowance - NB: Not contribution based The Guaranteed Element of State Pension Credit Universal Credit (during the roll out stage of the benefit only) Support under part VI of the Immigration and Asylum Act 1999 Child Tax Credit (with no entitlement to working tax credit) and an annual gross income of less than 16,190 You must provide proof of current entitlement to the above benefits Are you a: Young Carer - supported by Suffolk Young Adult Carers team (please provide a letter as proof) If you have completed section 2, please go to section 4 Section 3 - Discretionary Bursary Earnings from work (from P60/P45) You may still apply if your total gross household income is 25,000 or less per annum per annum Contribution based JSA / ESA Pension Working Tax Credits & Child Tax Credits Other (please specify) TOTAL You must provide proof of current entitlement to the above, for example by giving us your Tax Credit Award Letter or an up to date P60 (dated April 2017 or after) Section 4 - Childcare Do you need help with the costs of childcare? No Yes Please complete the additional Application for Childcare Costs form Child care is only available to students aged 20 and over as at 31 August If you are still aged 19 as at the 31st August, you may be eligible for help under the Care To Learn scheme instead. Please contact Student Support for more information.

3 Section 5 - Bank Details You must have a bank account in your own name in order to apply for a bursary, as we can only make payments directly into a bank account which must be in your name. We regret that we cannot pay by cheque, and therefore payments may be withheld until you have a bank account that accepts BACS (we cannot pay into Post Office basic bank accounts). Bank / Building Society Name Branch Location Name of Account Holder Sort Code (6 digits) Account (8 digits) Building Society Roll Number (applies to Building Society Accounts only) Section 6 - Proof of Income Please ensure that you have included copies of all relevant proof of income or benefits to allow us to assess your application. If we do not have all the information, your application may be delayed, and you may lose some weeks of your bursary. Referring to the relevant sections, have you included the following: Copies of proof of entitlement to any / all of the benefits listed in section 2 above (all pages) Copies of current tax credit award letter (all pages) or copies of latest 3 payslips for every member of the household Copies of any letter from Suffolk Young Adult Carers confirming that you are a young carer If you cannot provide any of the above, you must provide the following: Copies of the last three months worth of bank statements for every person in the household so that we may make an assessment of your monthly incomings and outgoings. Please note that this will slow your application down. Section 7 - What can the bursary help with If eligible, you can get a weekly sum towards the costs of attending College, and help towards additional course costs. If you have been given an order form by your tutor, please indicate below, how you would like to proceed: I would like the College to order, and have enclosed the appropriate order form I have already purchased the above, and attach receipts

4 Section 8 - Further Information Please provide details below of any further circumstances that you think may assist us in assessing your application.

5 Section 9 - Declaration PLEASE READ THE FOLLOWING DECLARATION CAREFULLY BEFORE SIGNING: I declare that the information that I have given on this form is complete and accurate to the best of my knowledge. I undertake to supply any additional information that may be required to support this application. I understand that if I refuse to provide any information that is requested and that is relevant to my claim, this application will not be accepted. If my circumstances change I undertake to inform Suffolk New College immediately. If I withdraw from my course, I undertake to return any equipment or kits given to me from the Bursary Fund. I agree to repay Suffolk New College in full, and immediately, for any/all sums paid to me if the information given upon this form is shown to be false or deliberately misleading. I am aware that any award from the Bursary Fund is for this academic year only, and that I must re-apply every year that I continue to study at Suffolk New College, and that there is no guarantee that I will receive funding in future years. Signed By - Student Please ensure that you have completed the application form, and have submitted all the necessary evidence including photocopies of all relevant benefits letters / proof of income. Please do not submit originals. Forms not completed correctly will not be processed. If you require any help or assistance in completing this form, please contact the Student Support Team Please forward completed forms, either by post, or in person to: Student Support Suffolk New College Rope Walk Ipswich IP4 1LT Data Protection Act (1998): The information that you give on this form will be used for the purpose of processing your application for the Suffolk New College (the College) Bursary Fund and the Suffolk New College Free School Meals Fund. The College is under a duty to protect the public funds they handle and may use the information you provided to prevent and detect fraud. It may also share this information for the same purposes with other organisations, including the DWP, which handle public funds. Disclaimer The information contained in this document is correct as far as can be ascertained at the time of publication, but the College reserves the right to alter details, without notice, as notified by the various funding bodies.

6 For Office Use Only Date Received in Finance: Assessed By: Approved In query Rejected Comments: AMOUNTS AWARDED: Bursary Kits / Equipment Uniform Trips Materials Books DBS Check Childcare TOTAL BURSARY Date Bursary Allocated: Input By: Symmetry A/C No: EBS Updated On: Date FCM Allocated: Input By: Comments: