APPLICATION FORM
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APPLICATION FORM APPLICATION FORM Document Transcript

  • APPLICATION FORM FOR DISCRETIONARY FUNDS AND CHILDCARE FUNDS If you have any queries please contact your Campus Student Support Adviser √ Tick one or more I am applying for assistance with: Childcare costs  complete sections 1,2,3,4,5 and 6 Part-time course-related costs  complete sections 1,2,3,4,5 Unforeseen hardship  complete sections 1,2,3,4,5 Dyslexia Assessment  complete sections 1,2,3,4,5 Living costs ie accommodation, debt, household shortfall of income complete sections 1,2,3,4,5 CAMPUS Reception Email Please return forms to Telephone Number Student Funding and Paisley 0141 848 3803 funding.advicepaisley@uws.ac.uk Advice reception J219 Student Services Reception Ayr 01292 886267 funding.adviceayr@uws.ac.uk J108 University Student Services, Dumfries and Galloway College Building, Bankend Dumfries 01387 702088 Studentservices-dumfries@uws.ac.uk Road, Dumfries, DG1 4FD Student Services Reception, Beckford Hamilton 01698 894448 funding.advicehamilton@uws.ac.uk Building, Hamilton Campus
  • HELP US TO HELP YOU – helpful hints to avoid delays. • Answer all questions. If not applicable please write N/A. • If your income exceeds your expenditure we cannot financially assist you. • Use the Checklist in section 5 missing evidence documents will delay your application. • All income must be calculated as monthly. If your loan is not paid monthly please divide your yearly allowance by 10. • We do not require evidence for household bills, unless you have a large arrears bill. • Apply to your enrolled campus only. • Closing date for final year students is the last Friday in April. Childcare Fund The Childcare Fund provides assistance to full-time HNC, HND, Degree and PGCE teacher training students attending a course as defined by Students Awards Agency for Scotland (SAAS). with the cost of formal childcare expenses. “‘Formal” childcare includes childminder, after school clubs and providers of day care and education. Family and friends do not constitute “formal” childcare. Students are eligible if they: • are eligible for tuition fee support from SAAS • are either UK domiciled or eligible for student loan support • have applied for the maximum student loan to which they are entitled Not Eligible- Postgraduates, students supported under the Nursing and Midwifery Student Bursary Scheme, and part time students. However, Postgraduates and part-time students can apply for Discretionary Funds. Full-time students’ Discretionary Fund The purpose of this fund is to: • provide non-repayable assistance to students in financial difficulty in order for them to access and / or continue in Higher Education. Students are eligible if they: • are full-time students undertaking HNC, HND, Degree or equivalent courses and Post Graduate students on SAAS funded courses. • Students are required to apply for the maximum Student Loan to which they are entitled, unless they are only applying for the cost of an Educational Psychologist Assessment. • Postgraduate students can also apply. Not Eligible- students supported under the Nursing and Midwifery Student Bursary Scheme and part time students. Part-time students’ Discretionary Fund The purpose of this fund is to: • assist part-time students with course-related costs and financial hardship, (including help with travel, childcare and book costs etc, but not the cost of tuition fees) • prioritise support to students in receipt of state-related benefits, lone parents and those who would have previously qualified for the part-time Student Loan. Not Eligible- students on non-means-tested NHS Bursary funded courses and Postgraduate students (with the exception of PGCE students). Means-Testing of household income The University is required to distribute the funds on behalf of the Student Awards Agency for Scotland, according to the needs of the individual student and consequently is required to obtain details of the student’s monthly income (including the partner’s income and parental contribution where applicable) in order to determine need. Applications are normally processed within 4 weeks of receipt of a fully completed form. Payment is made by cheque. Substantial cheques may be paid direct to a childcare provider or housing provider.
  • OFFICIAL USE ONLY Paisley Ayr Dumfries Hamilton Date received Initial input Screened/enrolled awarded refused cancelled Top-up awarded Top-up awarded SECTION 1 Personal Details Name: ________________________________ Banner ID number: ____________________ Date of Birth: _________________________ Age: __________ Term Address: Home Address (if different): ____________________________________ _____________________________ ____________________________________ _____________________________ Post Code: ____________________________ Post Code: ____________________ Tel. No: ______________________________ Mobile no: _____________________ E-mail address_____________________________________________________________ Status: Living with spouse/partner Single Financially dependant children: Yes No How many? Ages Course Details Are you? Undergraduate Postgraduate Are you? Full-time Part-time Course Title: _________________________________________________________ School _________________________ If full-time Year of Course 1st 2nd 3rd 4th 5th When do you expect to graduate? ___________________ month _____________ year How many modules are you completing? Semester 1 Semester 2 Summer
  • SECTION 2 Housing, Debts and Childcare costs HOUSING Does more than one person contribute to the Rent or Mortgage? Yes No If ‘yes’ how many in total contribute? Please tick the box which best describes your housing arrangements. Parental home Rented / owned Living with family / friends University Halls DEBTS University debts (Please complete the total outstanding balance) Halls fees £ Tuition fees £ Other £ Other debts (excluding overdraft) Please provide documentary evidence of outstanding balance, if you would like these to be taken into account. You can add additional list if you need to. Creditor Min. Monthly Outstanding Comments regarding account Amount Balance £ £ £ £ £ £ £ £ CHILDCARE COSTS If your childcare provider is a Registered provider – please ask them to complete SECTION 6 at the back of this form. (This can be removed and then returned with your application form) If your childcare provision is an informal arrangement, please ask the person who is looking after your child /ren to provide a letter detailing the weekly cost, and how many weeks this covers, for each child. Are you in receipt of other funding to pay for childcare costs? (please complete total income for the year from September to June) SAAS or equivalent Trust Fund e.g. Elizabeth additional childcare £ Nuffield Trust £ Grant Working Tax Credit Other (please state) £ childcare element £
  • SECTION 3 Income and expenditure MONTHLY INCOME SELF PARTNER Student Loan £ £ Parental Contribution £ £ SAAS/LEA/Library Board Awards including YSB, dependants, childcare & lone parent grants £ £ SAAS/LEA Travel Expenses (estimated) £ £ Trust/Scholarship £ £ Earnings £ £ Child Tax Credit/Working Tax Credit £ £ Housing Benefit £ £ State Benefits/Pensions (excluding DLA) £ £ Child Benefit £ £ Child Support Maintenance £ £ Student Union Hardship Fund £ £ Other income (please specify) £ £ £ £ TOTALS £ £ TOTAL JOINT INCOME £ MONTHLY EXPENDITURE If you have a partner/children give your family expenditure. If you are single and sharing give your own contribution only. Housing Rent/Mortgage £ Council Tax £ Other Housing Costs Endowments, House Insurance, Factor Bills etc £ Bills Gas & Electricity £ TV Licence £ Telephone £ Food/Housekeeping £ Travel Costs Including car & Public transport costs £ Others Course Books/Equipment/Course Costs £ Debt Repayment(as itemised in section 4) £ Clothing £ Entertainment £ Childcare (as itemised in section 5) £ Tuition Fees £ Additional £ Please specify EXPENDITURE MONTHLY TOTAL £ MINUS INCOME MONTHLY TOTAL £ EXCESS/SHORTFALL £ Do you have any savings? Yes No If If yes, please total here £………………… Do you have an overdraft? Yes No If yes, what is your current overdraft level? £………...
  • SECTION 4 Supporting Statement and Declaration Please provide a detailed description of your financial, personal, and exceptional circumstances or any additional information you feel might support your application, including how you are trying to improve your situation. (You can attach a separate sheet of additional information if you need to) Part-time students only. Please complete your course related costs here. Travel: How much will it cost you per week to travel to your campus? £___________ Total for the session £___________ Childcare costs: Please ask your childcare provider to complete the Appendix at the end of this form or, if not registered, to provide a letter confirming the amount paid. How much will childcare cost you per week? £___________ Total for the session £___________ Books, Equipment: How much will it cost you in total for materials for the session? Total £___________ Hamilton students multiply weekly costs by 33 and Dumfries Paisley and Ayr students multiply their weekly costs by 32. Declaration and signature I …………………………………………………… declare that the information I have given is accurate and I understand that a false declaration will invalidate my application. I authorise the Student Support Advisers to make an independent check on any evidence produced within this application. I acknowledge that the outcome of this application will remain confidential between the funding and advice service staff and myself. I understand that it is entirely my own responsibility to ensure that I include all relevant documents and information with my application. Fraudulent claims will be reported to the relevant authorities. Please note the University is required to audit check a percentage of awards made to students. Signature: ………………………………………………………………… Date…………………………..
  • SECTION 5 Checklist Supply photocopies of the following items of information in support of your application. Original documents cannot be accepted. ALL STUDENTS MUST SUPPLY THE FOLLOWING 5 ITEMS TICK Banner or student ID card SAAS or Equivalent Award Letter - both sides Student Loans Company or Equivalent Credit Agreement/Payment Schedule Letter Bank/Building Society statements / printout - showing 4 weeks banking transactions within 2 weeks of the submission of the application- for yourself & partner if living with spouse / partner Autoteller printout with your name written on it- for all bank accounts as at date of application INCOME EVIDENCE TICK (tick and supply only those which apply to you) Earnings - payslips only Partner/spouse earnings - pay slips only Child tax / working tax credit - Inland Revenue award document Child benefit - first & second page of book or highlighted in bank statement Benefits received - received inc DLA, JSA, Housing benefit, Income Support etc Child Maintenance Payments - letter confirming amount received Savings - bank /account statements EXPENDITURE EVIDENCE (tick and supply only those which apply to you) TICK Rent - lease agreement showing amount paid, signed by you Mortgage - letter confirming payment or highlighted on bank statement if recognisable as a mortgage payment. Dig money - letter from persons receiving the monies, detailing payment amount and what this covers Council tax - invoice, if applicable Other housing costs - please include evidence of all other housing costs Insurance payments - i.e. life, household, car etc Debt - credit card statement, store cards bills, loan agreements etc Childcare costs - completed confirmation of childcare provision form or letter Child Maintenance Payments - letter confirming amount paid
  • For Official Use only FT Discretionary Fund: 4328 AO1 Childcare Award: 4328 A03 Part-time Discretionary Fund: Date Payee Amount Monthly loss x10__________ Pg £ Other costs __________ DF £ £ Total loss __________ Pt DF £ £ Award __________ CC £ £ RUK £ Comments £ £ CTB £ AUTHORISED BY maint accom debt travel disability childcare other CHILDCARE costs £ Discretionary Fund Running Totals £ Date Payee Amount comments Pg £ DF £ £ Pt DF £ £ CC £ £ RUK £ AUTHORISED BY CTB £ maint accom debt travel disability childcare other CHILDCARE FUND costs £ maint accom debt travel disability childcare other CHILDCARE costs £ Discretionary Fund Running Totals £ Payee Amount comments Pg £ £ DF £ £ Pt DF £ CC £ RUK £ AUTHORISED BY £ maint accom debt travel disability childcare other CHILDCARE FUND £ costs £ CTB £ maint accom debt travel disability childcare other CHILDCARE costs £ Discretionary Fund Running Totals £
  • University of the West of Scotland Student Services SECTION 6 Confirmation of Childcare Provision Use for Registered or Approved Childcare providers only) Student’s name: _____________________________ Student Banner ID___________________ If you have more than one childcare provider, please complete a separate form for each. Under weekly cost, please enter only the cost you are liable to pay. Do not include the cost of any local authority funded sessions. Name of child DOB Weekly cost No of weeks Total for required year Childcare providers will need to supply a Registration number. Approved organisations under the Tax Credit (New Category for Childcare Provider) Regulations 1999, will have to provide a reference number. I confirm that I have agreed to provide childcare as shown above. Signed: Full Name: Date: I am registered with or my accredited organisation is Name Address Post Code My registration number (or my approval reference is Name, address and telephone number of childcare provider (cheques will normally be made payable to the childcare provider) Name Address Post Code Telephone Number Cheque made out to _______________________________________________________________