The University of Northampton

Carers Award 2015/16

Office Date: / /

Ref No:

/ /
1.  Students must meet the following criteria:
·  You are a ‘Home’ student enrolled on a full-time undergraduate or postgraduate course at the University of Northampton.
·  You must have applied for and taken out your full entitlement to student funding from your local funding authority before applying OR as a postgraduate have made adequate provision to pay your fees and living costs and can provide evidence of this. (see page 4)
·  You must be responsible for the care of a relative due to disability, chronic/terminal illness, mental health problems or similar who you live with full-time
·  You must have been in receipt of Carers Allowance or be able to provide proof that you are a carer.
2.  Return your completed form to:
The Financial Guidance Team, The Student Centre, Park Campus, The University of Northampton, Northampton, NN2 7AL.
Applications can be handed in to the Student Centre, Park or Avenue Campus or scanned and emailed to .
3.  If you would like help to complete this form, please contact the team on 01604 892833.
4.  The maximum support available is £1,000 per year. Support for future years of your course is not guaranteed and is subject to funds being available.
5.  The deadline for receipt of applications and all supporting evidence is 31st July 2016, subject to funds remaining available.
Part 1: Your personal details
1 / The University of Northampton student number
2 / Full name
3 / Date of birth (DD/MM/YY) / Gender: / Male / Female
4 / Term time address / Home address (if different)
Postcode:
/ Postcode:
5 / Telephone number / Mobile number
/ 6 / E-mail address
Part 2: Course details
8 / Course title
Undergraduate / Postgraduate
9 / Are you studying: / Full-time? / Part-time?
10 / Date you first enrolled on your course (DD/MM/YY)
11 / Which year of study are you in? For example, 1st year, 2nd year.
Part 3: Bank/Building society details
Please provide a copy of your bank or building society statement showing your account details below. Any payment you may receive will be paid directly into your bank account.
The statement must show your name, account number and sort code – mini statements and photocopies of bank cards are not acceptable. Statements printed from the internet may be accepted, but only if your account name, account number and sort code are also printed on these statements.
Please inform us immediately of any changes to your bank details
Name of bank / Account name
Sort code / Account number
Office use: Bank details verified – FAF assessors initials and date
Confidentiality
Applications are seen only by The University of Northampton Financial Assistance Committee and Student Services staff. It may be necessary for additional supporting information to be sought from other university staff in order for the Committee to reach a decision.

Data Protection Act 1998

The University of Northampton is a data controller in terms of the 1998 legislation. The Student Services Department follows University policy in matters of data protection. The data requested in this form is covered by the notification provided by the University under the Data Protection Act. Personal data will be used solely by the University for statistical purposes and electronic record keeping.
The data will not be passed to any other third party without your consent, except when the University is required to do so by law. Any formal enquiries concerning the use of data noted here should be addressed to the Head of Student Services.
Part 4: Declarations
I certify that to the best of my knowledge, I fulfil the following criteria:
(please tick the relevant boxes)
i)  I am a UK national/British Citizen; or
ii)  I am settled* within the United Kingdom (UK) (i.e. I have the right of abode in the UK or have been awarded indefinite leave to remain); or
iii)  I have been recognised by the UK government as a Refugee; or
iv)  I have been granted Humanitarian Protection (HP) by the Home Office; or
v)  I am an EEA or Swiss Migrant worker or the family member of an EEA or Swiss Migrant worker and you /your family member intend to continue to work while studying; or
vi) I am an EU national who has been ordinarily resident in the UK for the three years prior to the first day) of the first academic year of my course; or
vii) I am the child of a Swiss national; or
viii) I am the child of a Turkish worker
*settled – on the first day of the first academic year of your course.
Plus, I was ordinarily resident in the UK of the first day of the first academic year of the course, and
I fall under (i), (ii) or (iv) or (vi) above and I have been ‘Ordinarily Resident’ in the UK and Islands for the 3 years immediately before the first day of the first academic year of my course, and none of this time was wholly or mainly for the purpose of receiving full-time education, if it was I was resident in the EEA immediately prior to this 3 year period, or
I fall under (iii) above, or
I fall under (v) or (vii) above and I have been ordinarily resident in the EEA and Switzerland for 3 years immediately before the first day of the first academic year of my course, or
I fall under (viii) above and I have been ordinarily resident in the EEA, Switzerland and Turkey for the 3 years immediately before the first day of the first academic year of my course.
·  I confirm that I am registered and in attendance on the course described in Part 2.
·  I am agreeable to any investigation made to verify the accuracy of the information.
·  I declare that the information I have given on this form is correct and complete to the best of my knowledge. I agree to inform you of any alterations to the information given.
·  I understand that giving false information will automatically disqualify my application and may lead to disciplinary action as outlined in The University of Northampton General Student Regulations. I further undertake to repay any grants obtained by me as a result.
Please provide the evidence listed overleaf with your application.
Your name (CAPITALS) / Your signature / Date
Student Checklist – please provide the following evidence
Copy of your bank/building society statement – This must show your full name, account number and sort code details.
Copy of your student funding letter for 2015/16 – This must show that you have been assessed for support from your funding authority (i.e. Student Finance England, NHS Student Bursaries, etc) and that you have applied for and taken out your full entitlement to funding for this academic year. OR for postgraduate students Information showing that you have made adequate provision to cover your course fees and living costs – i.e. details of any sponsorship, work contracts, pay slips, savings and other income you are in receipt of. Please refer to the ‘How does it work?’ booklet pages 8 and 9 for the expected level of provision you should be able to demonstrate.
·  Evidence you have been in receipt of Carers Allowance
Or
·  A supporting letter from an appropriate professional i.e. a letter from your GP, other medical professional or manager of a Carers Centre confirming your role as a carer
Or
·  A supporting letter from a local voluntary sector young carers project on their headed paper
Or
·  A supporting letter from your school or college explaining and confirming your status as a carer for someone with long-term ill-health or disability on headed paper
Office use only - Assessment notes
Entitlement / £ / Payment date
Enrolment details: Staff initials and date records checked
QLS check enrolled Y/N / Home status? Y/N
Moulton course? Y/N
Assessor initials and date
Comments: