For office use only
DATE
WJH REF

APPLICATION TO THE ‘WHAT JUST HAPPENED’ FUND

You are applying on behalf of yourself, or a friend or family member, for help towards costs incurred while you were in hospital recently.

Please complete all the sections that are relevant to your application. You may apply for more than one category i.e. Travel, Accommodation, Subsistence etc., however the combined amount awarded will not exceed £200.00.

Please provide PHOTOCOPIED evidence for each expense claimed.

For example: Train tickets, hotel/B&B invoices, receipts for food or parking tickets.

When you have completed the form and have gathered all of the required evidence, please securely send it to:

THE STUDENT FUNDING UNIT, 4TH FLOOR NANCY ASTOR BUILDING, PLYMOUTH UNIVERSITY, PLYMOUTH, DEVON PL4 8AA

We will deal with your application as soon as possible and will contact you, and the person for whom you are making the claim, as soon as possible.

IS THIS APPLICATION FOR YOURSELF YES/NO
IS THIS APPLICATION ON BEHALF OF SOMEONE ELSE YES/NO
PLEASE PROVIDE INFORMATION ABOUT YOURSELF
YOURFULL NAME
YOUR UNIVERSITY NUMBER
YOUR DATE OF BIRTH
YOUR EMAIL ADDRESS
Nature of the medical
emergency
Hospital name
Hospital & ward name
IF THE APPPLICATION IS NOT FOR YOURSELF, PLEASE PROVIDE INFORMATION ABOUT YOUR FRIEND OR FAMILY MEMBER WHO IS THE PERSON THAT WILL BENEFIT FROM THE FUND
FULL NAME
AND POSTAL ADDRESS
Their relationship to you / FRIEND/FAMILY/OTHER please state
IS THIS PERSON A STUDENT / Y/N if Yes, provide student number below
Their student number
FULL DETAILS OF THE COSTS THAT YOU WOULD LIKE HELP WITH
REQUEST FOR HELP WITH TRAVEL COSTS
Details of journey
Method of travel CAR/TRAIN/BUS/OTHER (specify)
Cost £ single/return
TOTAL COST£
Evidence provided? Y/N
PLEASE TELL US WHAT YOU HAVE PROVIDED
REQUEST FOR HELP WITH ACCOMMODATION
Type of accommodation HOTEL/B&B/HOSTEL/OTHER (specify)
Name & address of hotel/B&B etc
Cost per night £
Number of nights required
TOTAL COST £
Evidence provided? Y/N
PLEASE TELL US WHAT YOU HAVE PROVIDED
REQUEST FOR HELP WITH SUBSISTENCE/PHONECALLS/PARKING
Cost of meals/snacks/beverages £
Cost of phone calls £
Cost of parking £
TOTAL COST OF £
Evidence provided? Y/N
PLEASE TELL US WHAT YOU HAVE PROVIDED
BANK DETAILSOF PERSON THAT WILL RECEIVE PAYMENT FROM THE FUND
Name of account holder
Account Number
Sort Code
FOR OFFICE USE
AWARD APPROVED / Y/N
DATE
AMOUNT APPROVED / £
AUTHORITY
CATEGORY / TRAVEL/ACCOMMODATION/SUBSISTENCE/PARKING
PAYMENT BY BACS / Y/N
DATE OF PAYMENT
PAYMENT IN CASH / Y/N
DATE OF PAYMENT
HAS APPLICANT PROVIDED DOCUMENTS / Y/N if YES, tick what has been provided
  • Travel tickets/ petrol receipts
  • Accommodation receipt
  • Receipts for food

DETAILS OF BACS PAYMENT
DETAILS OF CASH COLLECTION
COMMENTS