Financial Support 2017-2018

19+ DLS Bursary Fund Application Form

NOT for Advanced Learner Loan Applicants

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 2 YEAR COURSE THEY BEGAN AGED 16-18 OR THAT HAVE AN EDUCATION, HEALTH AND CARE PLAN MUST APPLY FOR FINANCIAL SUPPORT FROM THE 16-19 BURSARY 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
Do you have an Education, Health and Care Plan? (Please circle)
*If yes please complete the 16-19 Bursary Fund application form. / YES* NO
What do you wish to apply for? (Please tick)
Bursary / Travel / Kit/Uniform
specific courses only / Childcare / Fees
(Second level 2 or
ESOL qualifications ONLY)
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 at 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

SECTION 1 - Household Details (Please tick)

I live with parent(s)/guardian(s) and have NO income.
Please give details* and continue to Section 3 / I live with my parent(s)/guardian(s) and have my own income
I live with my partner (i.e boyfriend/girlfriend) / I live independently
I live with my partner and child(ren) / I live independently with my child(ren)
Other domestic situation
Please outline
*If you have no income, please explain how you are supporting yourself (e.g. paying for food, clothes etc.)

SECTION 2 - Own/Household Income

Please tick Yes or No / Y / N / Evidence enclosed / P
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 pages
or most current award letter latest 3 months bank statement
Income Support / 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
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 / 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 3 - Childcare Support

Do you require support with childcare costs during your college/placement hours / Yes No
How many Children / Please state their ages
If you are aged 20+ on the 31st August 2017, you are eligible to apply for childcare support from the 19+ Discretionary Support Fund. Please contact the Learner Finance Team to request a Childcare Registration Form which provides detailed terms and conditions. The Childcare Registration Form requires completion by yourself and your childcare provider; without the form your childcare claim cannot be processed, so please return it as soon as possible. Any questions relating to this please call 01262 455202. Please note no childcare will be allocated if a spouse/partner is at home to look after the child(ren)
If you are aged 19 on the 31st August 2017 you must apply online through Care2Learn www.gov.uk/care-to-learn

SECTION 4 – Supporting Information

Please give details as to 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.

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

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

All support is paid in arrears and is dependent on satisfactory progress and at least 90% attendance on your course including 90% attendance at English 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…? / P
·  Answered every question
·  Enclosed ALL the evidence of income we require
·  Provided 2 photographs and completed the EYMS bus pass form if using EYMS/ER1 buses
·  If you require childcare support, requested a Childcare Registration form.
·  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 e-mail
SECTION 7 - Declaration
This section MUST be signed by the applicant
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 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 and will only receive any funding agreed on the next payment run.
·  If I request financial support towards course fees I am therefore declaring that I am NOT eligible for an Advanced Learner Loan.
·  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 detect fraud. 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 Dated

Please print full name

Office use only

Date Received / Initial
Assessment / 19+ DLS Award Agreed
Annual Income / Award
Rejected / Reason Rejected:
£ / Childcare / Yes No / Childcare Weekly / £ / Childcare Weeks
Hardship
Bursary / £ / Kit/ Uniform / £ / Fees / £ / Other / £
Travel Method / Travel Daily / £ / Travel Weeks / Care to Learn / Yes No
Signed / Date
Signed / Date