APPLICATION FOR HE ACCESS TO LEARNING FUND - ACADEMIC YEAR 2017/18 What is it and who is it for? Hardship fund based on your income and expenditure while you re studying. Full time students must be in receipt of the full maintenance loan or have exceptional circumstances Part time students must be in receipt of a tuition fee loan (or made alternative arrangements) and be from a low household income (16845 per annum for single students) or have exceptional circumstances n-repayable How to complete this form Any questions? Use Blue or Black ink and write in CAPITALS Answer ALL questions. If you do not have enough space to answer any question, please attach information to the back of this form Provide documents for assessment and audit purposes Provide PHOTOCOPIES of documents required. Original documents may not be returned. The College does not accept responsibility for loss or damage of these. Call Student Financial Services on 01903 273014 or email sfs@nbcol.ac.uk Forename Surname D.O.B Office use only Application received Person code Course code Course Name
SECTION 1 - STUDENT S PERSONAL DETAILS Name at birth (if different from previously detailed) Your title Miss Mr Mrs Ms Your gender Male Female Your date of birth DD/MM/YYYY Your marital status Your age (in years) on 1st September 2017 Your full current home address and postcode Postcode Date you moved to this address DD/MM/YYYY Your current term-time address and postcode (if different from home address) Postcode Home telephone no. Mobile telephone no. Email address We will contact you by email unless you tick to indicate you prefer post Prefer post What is your nationality? Do you live Alone? With parents? With partner/spouse? In shared accommodation? Do you contribute to household expenses?
SECTION 2 - YOUR DEPENDENTS Do you have any children or adults who are financially dependent on you? - please give details below Adult or child Full name Date of birth SECTION 3 - DISABILITY/SPECIAL MEDICAL NEEDS Do you have a disability/ chronic medical condition? Have you applied for a disabled students allowance? Do you have any special equipment/materials not covered by the DSA (please attach additional sheet explaining)? Additional disability/ special needs SECTION 4 - FINANCIAL DETAILS ALL STUDENTS MUST ANSWER THE FOLLOWING Do you live with a partner/spouse? What is your household annual income before tax? Do you or you partner receive the following? - provide joint details - provide your details Income support Working/Child Tax Credit Jobseeker s Allowance Housing Benefit Carers Allowance Employment & Support Allowance Disability Living Allowance/ Universal Credit Other - state below Personal Independence Payment
SECTION 4 - FINANCIAL DETAILS CONT. General living costs, ie food, utilities etc, are considered in your assessment as standard, although the following considerations can also be taken into account How do you pay for your accommodation? Rent Mortgage Do you have additional equipment costs? - please detail Do you have any priority debts that need to be repaid whilst you are studying? - please detail Do you have any other costs not previously detailed? - please detail SECTION 5 - ADDITIONAL COSTS FOR PARENTS/DISABLED STUDENTS If you have children, or are disabled, complete Section 5. If not, go to Section 6 Do you have a mobile phone? Do you have vehicle costs? - Monthly cost - please detail Petrol weekly Car tax Car insurance Car maintenance SECTION 6 - COURSE DETAILS Your course name Your course code
SECTION 7 - TRAVEL DETAILS How do you travel to College? Public transport Car/Motorbike Walk/Pushbike SECTION 8 - SUPPORTING STATEMENT Please state why you are in financial difficulty and why you believe your situation warrants additional financial support
SECTION 9 - PAYMENT DETAILS Any allocation due to you will need to be paid directly into your bank account Bank name (eg HSBC) Bank Address Account Number (8 digits) Sort code (6 digits) Account holder (eg Mr J Jones) THE BANK ACCOUNT MUST BE THAT OF THE APPLICANT PLEASE WRITE CLEARLY SECTION 10 - ACCESS TO YOUR INFORMATION Under the Data Protection Act 1998, we will not pass any of your information to anyone other than those bodies stated in your declaration. Should you require us to be able to discuss your application with a person other than yourself (eg your parent/interpreter), please provide their details below: Full name Postal address Relationship to you Please sign here to agree that the College may discuss your financial situation with the person detailed above Signed Print name Date
SECTION 11 - EXTRA INFORMATION Please ensure you have attached all the following information, where applicable: All students Three months bank/building society statements - please explain on statements any credit or debit over 100 (same account that student loan is paid into) Rental agreement/mortgage statement/ letter from parents confirming contribution to household expenses Copy of your partner s income - 2017 P60 (if applicable) 2017/18 tax credit award notice (if applicable) 2017 child benefit letter or child(rens) birth certificates (if applicable) Childcare costs (if applicable) Benefit award notices dated after April 2017 (if applicable) Priority Debt Evidence i.e. Statements, repayment agreement and... Full time students College Payment Advice You must have applied for the full student loan before you can apply for this fund Part time students College Payment Advice Evidence of your income - 2017 P60 (if applicable) Benefit Award tices dated after April 2017 (If applicable) Professional & Career Development Loan evidence (if applicable) Students must have applied for and be in receipt of support from Student Finance England
SECTION 12 - DECLARATION You MUST sign this declaration The information I have given on this form is complete and accurate to the best of my knowledge. I understand that if I give GBMET false information, or do not give complete information, I may be refused assistance now and in the future, or I may be prosecuted and my financial assistance withdrawn. I understand that some of the information provided in this form and details of any allocations I am awarded may be shared with other organisations that handle public funds in order to prevent / detect fraud. I agree that the information I have provided and details about any grant I am awarded may be passed to the person I have detailed in section 10 of this application form. I understand that by applying for funding it is not a guarantee that my costs will be covered. I understand that if I receive a kit or funds towards equipment from the college in advance of my assessment being completed and/or: I am refused My application is cancelled I do not start my course/withdraw from my course that I will be liable for the cost or if I have received an allocation, I will be required to repay GBMET. I have read and understood the Prioritisation and Criteria Documents. The deadline date for applications is the 31st March 2018, providing funding is still available. Applications received after this date may not be accepted. Data Protection Act 1998 The information that you give us on this form will be used for the purpose of processing your Access Fund application. rthbrook College Sussex is under a duty, for the purpose of processing your application, to protect the public funds they handle and may use the information you have provided on this form to prevent and detect fraud. It may also share information, for the same purposes, with other organisations that handle public funds. Please sign to agree you have read and understood the above Signed Date Print name Check your application Check that you have: a a a Answered every question Signed the declaration and dated the form Enclosed all the proof we require - if you are unsure of what we require, please call us on 01903 273014 or email sfs@nbcol.ac.uk Where to send your application Student Financial Services rthbrook MET Littlehampton Road Worthing West Sussex BN12 6NU What happens next You will hear from us within 3 weeks for one of the following: To request further information/documentation OR To confirm your application is complete and what date you will receive a decision