16-19 Bursary Fund Application Form

Financial Support2017-2018

16-19 Bursary Fund Application Form

Please read the Terms and Conditions of Support and enclosed Guidance Notes before completing this application

Learners aged 19-23 and either continuing on a study programme they began aged 16-18 or that have anEducation, Health and Care Plan are eligible to apply for support from this fund.

LEARNER DETAILS

Forename / Learner ID
Surname / Date of Birth
Home Address / Age at 31st August 2017
Town / Post Code
Home Phone No / Mobile No
E-mail Address
Course Title / Start Date
Site of Study / Bridlington / Beverley / Hull / Other
Are you a returning student from 2016-2017?(Please circle) / YES NO
What do you wish to apply for?(Please tick)
Anyone aged 16-18 with a household incomeof £25,000or above is entitled to Travel only
Bursary / Travel / Kit/Uniform
specific courses only / Childcare
via Care to Learn scheme / Free College
Meals
Government set criteria
TRAVEL DETAILS(Please note: You will need to fund your own travel until support is agreed or you receive your bus pass)
If you live more than 2 miles from college please indicate your preferred method of travel.
If you intend to use an EYMS service please fill in an EYMS Bus Pass application and submit it along with this form
East Yorkshire Motor Service (EYMS)- including ER1(starting on Cottingham Road)
(Please provide 2 passport photographs and fill in an EYMS Bus Pass application form) / Photos & EYMS
Form Enclosed
College mini bus from Bridlington to Beverley plus EYMS return
(Please provide 2 passport photographs and fill in an EYMS Bus Pass application form) / Photos & EYMS
Form Enclosed
BC4(starting in Withernsea)or BC8(starting in Gilberdyke)
(Please provide 2 passport photographs with this form) / Photos
Enclosed
Other travel - By agreement only, please indicate method and reason below i.e. Train/Stagecoach/Bus King
TRAVEL ONLY APPLICANTS -If you ONLY require support for travel we do not need evidence of income but you must indicate your approximate household income level; please then go straight to and complete Section 4 onwards.
(Not available to students aged 19+)For audit purposes we will request evidence of income in the future from 5% of these applicants.
Under £25K / £25-27K / £27-29K / £29-32K / £32-35K / Above £35K

SECTION 1– Household Details(Please tick)

I live with Parent(s) / Guardian(s) / I live independently / I live with my partner
Other domestic situation:
Please specify eg. in care
Arethere any other persons aged under 19 living at the same address as you? / Yes No How Many?

About your parent(s)/guardian(s) - living at the same address as you

Forename / Surname / Date of Birth / Occupation

SECTION 2– Vulnerable Bursary

If you tick any of the statements below and provide the relevant evidence, you may be eligible for VulnerableBursary payments of up to £1200 for the full college year.(Not available to students aged 19+ on 31st August 2017)

Please Tick /  / Please Tick Evidence Enclosed / 
I am in care ora care leaver / Letter or Email from the relevant Local Authority confirming
your status
I claim Income Support(or Universal Credit in place of IS) in my own name / Benefit Award letter/s* dated within the last 3 months
OR an older letter AND a bank statement within the last 3 months
*Evidence must confirm that you can be in further education or training; please see a member of the Learner Finance Team for more details.
I receive DLA/PIP and ESA or Universal Credit in my own name

SECTION 3–Parent(s)/Guardian(s) Household Income

Please tick Yes or No / Y / N / Please Tick Evidence Enclosed / 
Earnings from work or
self-employment / Photocopy of latest P60 or 3 months wage slips / certified accounts or up to date Tax Credit Award Notice
Working/Child Tax Credit / Photocopy of FULL 2017-18 award letter - ALL pagesor
most current award letter latest 3 months bank statements
Income Support (IS) / Photocopy of each Benefit Letter dated within
the last 3 months OR an older letter
AND latest 3 months bank statements
Employment and Support Allowance (ESA)
Job Seekers Allowance (JSA)
Universal Credit
Carers Allowance
Pensions/Pension Credits
Housing Benefit / Current Confirmation Letter
(can be obtained from Local Council Offices - please
request the amount for each to be stated on letter)
Council Tax Benefit
Child Benefit / Photocopy of a recent Benefit Letter/Tax Credit Award Notice
or latest 3 months bank statements.
Other – Please specify
e.g. Maintenance/Savings/Rental income / Photocopy of documentary evidence
e.g. CSA letter or latest 3 months bank statements

FAILURE TO SEND IN ALL DOCUMENTARY EVIDENCE WILL MEAN A DELAY IN YOUR APPLICATION

SECTION 4– Supporting Information

Please give details of why you need financial support to enable you to attend college and complete your chosen course.

Applications will not be considered if this section is not completed

SECTION 5– Bank Details

All boxes must be completed. Money can only be paid into an account in the LEARNER’S name.

Bank Name
(e.g. HSBC, Halifax)
Sort Code (6 digits) / - / -
Account Number (8 digits)
Account Reference
(certain Building Societies only)
Name on Account

If the learner does not have a bank account he/she will need to open one.

All support is paid in arrears and is dependent on satisfactory progress and at least 90% attendance on your course including 90% attendance at Englishs and Maths (where applicable). If you are absent from college for any reason you should notify your tutor.

WHILE SOME ABSENCES MAY BE CLASSED AS ‘AUTHORISED’ THEY WILL STILL AFFECT YOUR OVERALL ATTENDANCE PERCENTAGE AND WILL RESULT IN PAYMENTS BEING REFUSED.

SECTION 6 - Check your application. Have you…? / 

• Answered every question
• Enclosed photocopies of ALL the evidence of income we require
• Provided 2 passport photographs if using BC buses or college minibus
• If using EYMS/ER1, completed the EYMS bus pass form and provided 2 passport photos
• Signed the declaration and dated the form on the next page (Section 7)

Please send your completed application form and evidence to:
Learner Finance, East Riding College, St Mary’s Walk, Bridlington, East Yorkshire, YO16 7JW
(This office deals with applications for ALL East Riding College sites)
OR you can deliver your application by hand to Reception at either Beverley or Bridlington
Any questions, please call us on 01262 455202 or 01262 455000 and ask for Learner Finance
or
SECTION 7– Declaration
This section MUST be signed by the applicant AND a parent/guardian (unless living independently).
I confirm that:

• The information I have given on this form is complete and accurate to the best of my knowledge.

• I understand that if I give East Riding College false information, or do not give complete information, I may be refused assistance now and in the future, or steps may be taken to recover any assistance paid.

• I understand that some of the information provided on this form and details of any funding I am awarded may be shared with other organisations that handle public funds in order to process applications and prevent / detect fraud.

• I agree that the information I have provided and details about any funding awarded may be passed to the person I have detailed as my guardian in section 1 on this form.

• I understand that funding is limited and my application or award does not guarantee support. The Discretionary Learner Support fund is limited; learners who are eligible for support are not automatically entitled to it and changes may be made to awards during the academic year subject to funds remaining.

• I understand that I have to buy any essential equipment/clothing prior to the start of my course myself and will only receive any funding agreed on the next payment run.

• I understand that I have to fund my own travel until my application has been agreed or a pass issued.

• I understand that if I leave my course before completion, I may be asked to repay in full or part of any support received.

• I understand that any support agreed is dependent on satisfactory attendance, behaviour and progress.

Data Protection Act 1988
The information that you give us on this form will be used for the purpose of processing your Bursary Fund application. East Riding College is under a duty, for the purpose of processing your application to protect the public funds they handle and may use the information on this form to prevent and detectfraud. It may also be share information for the same purposes and audit requirements, with other authorised organisations.

In signing this application you confirm that you have read and agree to the Terms & Conditions

Signed(Student) Print Name Dated

Parental/Guardian Declaration-I confirm that the information and income evidence provided in this application is complete and accurate

Signed Print Name Dated

Relationship to applicant

Office use only

Date Received / Initial Assessment / 16-19
LSF / CTB / VB
Annual Income / Award
Agreed / Free
Meals / No. of days/wks / Care to Learn / Yes No
£ / Award
Rejected / FCM
Rejected / Reason/s
Rejected
Hardship
Bursary / £ / Kit/ Uniform / £ / Other
(Trips etc.) / VB weeks @ £35pw
Travel Method / Travel
Daily / £ / Travel days/wks
Signed / Date
Signed / Date