NHS Nursing Students Placement Costs Bridging Loan

Transcription

1 NHS Nursing Students Placement Costs Bridging Loan Only complete this form if you are: An NHS Nursing Student, on a placement of 4 weeks or more and have no other means of support for the upfront costs. Please note that eligibility criteria apply, the loan is repayable and repayment will automatically be taken 8 weeks after the end of your placement (or earlier if applicable). Surname First Name Student ID For office use only: Date received Applications may be handed into the Student Support Centre or posted to Advice Service, Student Support Centre, University of Lincoln, Minerva Building, Brayford Pool, Lincoln, LN6 7TS. Queries to studentfundingteam@lincoln.ac.uk 1

2 SECTION 1: Terms and Conditions -- ALL STUDENTS MUST READ THIS PAGE. Are you eligible for this fund? You need to have demonstrated that you have explored all avenues of self-funding and still cannot cover your placement costs before applying for this loan: Are you in receipt of an NHS Student Grant and/or Bursary? Do you receive a reduced-rate maintenance loan from Student Finance? Do you receive a maintenance loan (not reduced rate) from Student Finance? Do you have a student bank account with overdraft facility (if eligible)? How much is the loan and how is it paid? Each loan amount will be assessed based on the costs involved, the amount reclaimable from the NHS (bearing in mind their thresholds) and University of Lincoln guidelines. Where the practice placement expense is excessive a contribution only may be loaned and in which case claims for reimbursements should be submitted within four weeks of the start of your placement. If successful, your loan will be paid by automated bank transfer (BACS) direct to your chosen bank account. An will be sent by the University notifying you that a payment has been made. Making a Practice Placement Travel Claim to the NHS? Claim forms for Practice Placement Expenses can be found on the NHS Bursary website: ALWAYS download your PPE Claim form from here as this will ensure you are using the most upto-date version. If you have to pay for accommodation upfront in one lump sum you can put in a claim to the NHS as soon as this payment has been made. You will need to complete the claim form, have it approved by the School of Health & Social Care, placement accommodation receipt (must show your name, dates paid for, cost and be on an official letterhead), bank printout (not mini-statement) showing the debit. It is your responsibility to provide the correct evidence for your claim and make the claim as soon as you have paid your eligible practice placement costs. For longer placements it is recommended that you make claims on a monthly basis. How is the loan repaid? Repayment of the loan will be taken automatically by the University 8 weeks after the loan has been issued. This allows time for you to have made a claim to the NHS and received repayment (the NHS will process your placement costs claim within 25 working days of receipt). Non repayment can result in legal action and your school being informed which could lead to issues regarding your fitness to practice. If you do not undertake your placement and so no longer incur eligible costs associated with your placement, you must repay your loan to the university immediately. These loans are solely for the purpose of practice placement expenditure and must not be used for any other reason under any circumstances. Is there any help and advice available? Familiarise yourself with the NHS Business Services Authority Knowledgebase (Ask Us?) If you require any assistance with this form please contact the Student Funding Team on or by to studentfundingteam@lincoln.ac.uk. For assistance with the payment and repayment of these loans please contact the Finance Department on

3 SECTION 2: Your Personal Details - to be completed by ALL applicants. Your title (tick one box only) Mr Mrs Miss Ms First name(s) Surname Gender Male Female Date of Birth / / Contact Telephone Number Contact Address Course title Mode of study: Full-time Part-time Which year are you in: Other Is this your Final Year? Yes No In most instances we will contact you by (via your University and personal address, if provided). However, we will need your term time address to see where you will be travelling from. Address: Postcode: SECTION 3: Your Placement Details - to be completed by ALL applicants Your placement address: Address: Postcode: Start date / / Finish date / / No. of Weeks Applying for help with: Accommodation and/or Travel costs* (please tick one or both) *What is the daily cost of travel from your term time address to University? *How many days per week are you on placement? 3

4 SECTION 4: Your Bank Account(s) to be completed by ALL applicants You must supply up-to-date evidence for ALL accounts held (this includes those accounts which have been recently closed). Please list all bank/building society accounts including current account, student account, savings account, ISAs, etc: Name of Bank/Building Society Type of Account held e.g. student, savings, etc Overdraft? How much If you are successful and an award is made, it will be paid by bank transfer. Please provide the details of the account you wish an award to be paid into: Bank Account Number Sort Code - - How much do you wish to borrow*? Accommodation Travel *We will make the final decision on how much you can borrow based on your evidence and NHS PPE Guidance. FOR OFFICE USE ONLY Date application received / / Loan Issuing Logging on: QLS checked Spreadsheet completed RCP Amount of loan agreed (accommodation) Amount of loan agreed (travel) Total Authorised: Second check: File sent to Finance dept: Payment made: Payment notification sent: Initials Initials Initials Notes: 4

5 Section 5: Declaration This MUST be read by ALL applicants and signed. I have enclosed photocopied evidence as follows (applications CANNOT be considered unless ALL evidence is received): Tick NHS Student Bursary award letter or printout from BOSS (if applicable) Student Finance England Notification of Entitlement 2017/18 Evidence of travel costs if applying for help with travel Evidence of accommodation costs official quote/booking form or invoice Term time tenancy agreement - if applying for help with accommodation Up-to-date detailed bank prints (not mini-statement) latest 4-6 weeks for ALL accounts I declare that I will submit an application to the NHS Student Bursaries Unit to reclaim my accommodation/travel costs as soon as possible. Initials I agree to information about my loan being shared with members of the Student Funding Team, the Finance Department and the School of Health & Social Care. I authorise repayment to be taken automatically 8 weeks after the end of my placement using the Recurring Card Payment Service (RCP) I have set up (see page 5). If I am reimbursed earlier I will contact the Finance Department to repay immediately. If I do not attend my placement or no longer incur eligible costs associated with my placement, I will repay the University immediately. I will not use this loan for any other purpose than for placement related costs which are eligible for refund by the NHS. I understand that failure to repay this loan will result in legal action being taken against me by the University of Lincoln and I may not be allowed to register with the Nursing & Midwifery Council at the end of my programme. I declare that the information that I have given on this form is correct and complete to the best of my knowledge. I understand that giving false information will automatically disqualify my application and any funds received will become instantly repayable. Signature Date Please note applications for bridging loans may take 2-3 weeks to process. 5

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7 NHS Nursing Students Placement Costs Bridging Loan Advance Payment Agreement by Debit/Credit Card We accept Mastercard, Visa Credit Card or Visa Debit Card by this method. If your card expires before the repayment date please contact the Finance Department on Your title (tick one box only) Mr Mrs Miss Ms Name Enrolment number Date of Birth Amount of Loan to be repaid Date of repayment (8 weeks from end of placement) I authorise the University of Lincoln to charge the above amount on the specified date in order to repay my NHS Nursing Placement Costs Bridging Loan. I understand that this document will be held securely and that the security number (CVC) will be destroyed after the Recurring Card Payment System is activated. Signature Date Cardholder name Cardholder address: Postcode: Card Type: Visa Credit Visa Debit MasterCard Card number / / / Start date / Finish date / Issue number CVC (last three digits on signature strip) 7