16-19 BURSARY FUND APPLICATION FORM 2018/2019

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Vivien Mosley
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16-19 BURSARY FUND APPLICATION FORM Please read the information below:- 2018/2019 You should read the attached 16-19 Bursary Fund Guidelines to make sure you are eligible to apply.

1 16-19 BURSARY FUND APPLICATION FORM Please read the information below:- 2018/2019 You should read the attached Bursary Fund Guidelines to make sure you are eligible to apply. Please complete all sections of the form and make sure you provide us with copies of the evidence we need. Your application will not be assessed without the correct evidence. The budget we have is limited so we cannot guarantee that we will be able to provide you with the financial support you request. Payments of all bursaries are dependent on you maintaining attendance of 80% + on all of your lessons and behaving appropriately, with no unauthorised absence or lateness. Section 1 Personal Details Full Name:. Date of Birth: Male: Female Address:.. Post Code:.. Telephone Number: Mobile:. address:.. JH AUG18 V8 Page 1

2 Section 2: Residency Please select which of the following applies to you: British Citizen Asylum Seeker EU/EEA Citizen Refugee Other (please specify.. Have you been resident in the UK or EU/EEA for the last 3 years? Yes No Section 3 Bursary Fund Levels:- Please tick 1 box only Level 1: Guaranteed Bursary This is for Students who are in care; young care leavers; young people in receipt of Income Support/Universal Credit in their own name; young people in receipt of Employment and Support Allowance or Universal Credit/Disability Living Allowance or Personal Independence Payments. Students will be eligible for a Bursary of up to a year. Level 2: Discretionary Bursary Students who were in receipt of Free School Meals or have a total household income of 16,190 or less. These Students receive full payment of any travel costs if they live more than 2 miles from NTG and Breakfast + Lunch voucher up to the value of 3.00 per day whilst attending at NTG and at their Work Placement. JH AUG18 V8 Page 2

3 Level 3: Discretionary Travel Bursary Students whose household income is more than 16,190, but less than 30,000. These Students will receive a contribution towards the cost of travel if they live more than 2 miles from NTG/Work Placement and Breakfast + Lunch voucher up to the value of 3.00 per day whilst attending NTG. Section 4: Household Income ( Required for Level 2 & Level 3 Bursary Applications) Please include the required original supporting documentation with this form. All evidence will be photocopied and dealt with in the strictest confidence. My Total Household Income is: Section 5: Required Financial Evidence Evidence should be dated within 3 months of the application. Household Income will relate to the Student and their family members with whom they reside. Please provide Tax Credits Award or Universal Credit Award Notification covering the April 2018/April 2019 Tax Year or: Evidence of household income showing who lives in the house and their related incomes. This may be Council Tax, Housing Benefit evidence along with proof of low income such as:- Income based Benefit Award letter (Income Support, JSA, ESA no more than 3 months old). Bank statement no more than 3 months old showing income based benefits or 3 months recent wage slips and P60 for all householders with Working tax credit evidence. Please note that we cannot process your application without the required evidence. JH AUG18 V8 Page 3

4 Section 6: Travel Please tell us how you intend to travel to/from your place of study. Tick all that apply Walk Cycle Car Bus Train Section 7: Bank Account Details Please fill in this section carefully and ensure the information you provide to us is accurate. We will normally pay you by BACS directly into your Bank Account. For that reason you must have a bank account in your name. Student Name:. Name of Bank:. Sort Code: Account Number: Please note: Payment will be transferred weekly to the Student s bank account via BACS upon authorisation that the student has satisfied all attendance and behaviour requirements. These payments will be made in arrears and there may be delays where there is a query relating to attendance. JH AUG18 V8 Page 4

5 Section 8: Student & Parent Guardian Declaration This declaration must be signed by all Students. If the income evidence provided belongs to parent(s)/guardian(s) then we must also have a parent/guardian signature. I/We certify that the information given is, to the best of my/our knowledge and belief correct. Any changes in personal, family or financial circumstances will be notified immediately in writing to BTA. Please note that giving false information which leads to incorrect or overpayment may result in the stoppage of future bursary payments and recovery of monies already paid. I/We understand that payments may be delayed or stopped if I do not maintain the minimum BTA requirement of at least 80%+ attendance on all my courses. For your Information:- The impact of bursaries on DWP Benefits Receipt of bursary funding does not affect receipt other means tested benefits paid to familes such as Income Support, Jobseekers Allowance, Child Benefit, Working Tax Credit and Housing Benefit. However if the student is in receipt of Disability Living Allowance or Personal Independence Payments, and Employment Support Allowance or in receipt of Universal Credit, parents can no longer receive certain household/family benefits for that child e.g Child Benefit Student Signature: Date:. Parent/Guardian s Signature: Date: JH AUG18 V8 Page 5

6 Office Use Only Date Application Received:. Guaranteed Bursary Discretionary Travel Application Status - Evidence received Complete: Yes No If incomplete please give more information on evidence required/action taken: Staff Signature:.. Date: Allocation of Funding Please tick relevant box/es Guaranteed Discretionary Travel Free Meals Additional. Date Decision Letter Sent:.. Bank Details Entered on Yorpay:.. Staff Signature: JH AUG18 V8 Page 6

7 Free Meals Application Form Please note you are not eligible for Free Meals if you are in receipt of Working Tax Credit Student/Parent Declaration: I/We confirm that the Student will be aged between 16 and 18 on 31 st August I/We have read and understood the guidance notes supplied with this application form and the information I/We have provided is a true reflection of our current financial status. I/We take full responsibility of informing BTA immediately should my/our financial status change. I/We acknowledge that the Student is eligible for free meals on residency grounds and can provide suitable evidence of proof if required. I/We understand that any misuse of the free meals system may result in the Students entitlement to free meals being withdrawn. Student Name: Signed by Student: Date: Parent/Carer Name Signed by Parent/Carer Date: JH AUG18 V8 Page 7

Further Education Learner Support Fund Application

Further Education Learner Support Fund Application Our bursary funds offer financial support to students who are in full or part time further education and are encountering financial barriers to learning.