C O N F I D E N T I A L

BURSARY FUND APPLICATION FORM FOR 2016– 2017

The Financial support available to students is as follows:-
  • 16-19+ Discretionary Bursary is for personal protective equipment, food and educational trips. Maximum award is £452 for students whose household income is below £10,000. The award is for the academic year 2016/17 only. The bursary is paid termly, the first payment is in November 2016.
  • Vulnerable Bursaryis for students who receive income support in their own right or are in care/ a care leaver or receive PIP*, DLA and ESA*. Students will be paid £40 per week for 100% attendance
  • 24+ Bursary is for students in receipt of the 24+ learning loan and is for educational trips, personal protective equipment books and course resources.
  • Free college meals are for students under 18 years of age, to have lunch on campus between 12 and 2pm each day to the value of £2.41. Students will be provided with a food card.
Please tick the bursary you are applying for:
Discretionary Bursary / Vulnerable Bursary / 19+ Bursary / 24+ Bursary / Free College Meals
.
Important Information
  1. Please make sure you complete all sections and only send photocopied evidence with your application form. All evidence to be provided is for April 2015 to March 2016 we cannot assess any evidence that is for after March 2016. If you do not provide the correct information requested; your application cannot be processed and will be returned to you.
  2. Be aware that we cannot accept responsibility for any evidence that is sent to us by post.

1.Student Details
Please provide your personal details.
Student Number :
Student Surname:
Student First Name:
Date of Birth: //
Age on 31st August 2016:
Student Mobile Number: / Address:
Postcode:
Student Home Telephone Number:
Student Email Address:
Are you a student who is a Care leaver or currently looked after in care YES NO
(if YES you must attach a letter from the Local Authority)
Have you been a resident in the UK for the last 3 years? YES NO
2.Course Details
Please provide us with as much information as you can about your course of study
Are you: / Full-time? / Part-time?(Please tick)
Course Title:
Level of Course
Course Start Date: //
Duration of course:
1 Year 2 Year / Centre of Study: (Please indicate)
Guisborough /Leeds
Middlesbrough / Newcastle
Newton Rigg / Scarborough
Shipley / Wakefield / York
Other
3. Bursary criteria and evidence required (your application cannot be proccessed without the correct evidence)
16-18 Discretionary Bursary:
(household income must be under £30,000 to qualify) /
  • P60 April 2016 OR Wage slips for the household for Jan. 2016, Feb 2016 and March 2016
  • Self-employment earnings, official tax Return from 2015-16
  • All benefits received including: Income Support, PIP, JSA,DLA, private pensions, housing benefit for April 2015 to March 2016 AND
  • All pages of Tax Credit Award Notice 2015-16 for working tax credit and child tax credit. Part Tax Credit Award Notices will not be assessed

Vulnerable Bursary: /
  • A local authority confirmation letter of staus if in care or a care leaver.
  • a recent copy of income support entitlement.
  • A recent copy of benefit entitlement letter if in receipt of ESA AND DLA or PIP

19+ Bursary /
  • All evidence as per the 16-18 Discretionary Bursary (household income must be under £30,000 to qualify)

24+ Bursary /
  • Copy of 24+ loan approval letter and all evidence of household income such as wage slips or benefits received.

Free College meals (household income must be below £16,900) /
  • Evidence of free school meals from local authority for 2015 to 2016.
AND
  • Evidence of household income from the discretionary bursary list.

.
4.FINANCIAL SUPPORT
The amount of financial assistance you will receive is dependent on your personal circumstances. It is intended to help you with the costs of overcoming any financial barriers you may have when attending learning. Please indicate what financial support you require:-
Type of Support Required: / Amount:
Course Equipment / £
Course Fees / £
Food / £
Protective Clothing / £
Transport / £
Trips / £
Other / £
-
5. HOUSEHOLD DETAILS
Please state who you live with and their relationship to you(please continue on separate paper if necessary):-
Name of household member / Age
(if under 16) / Relationship to Student
(e.g. mother, father, step father, spouse, brother, partner)
6.STUDENT BANK DETAILS
Please provide your bank details below, as printed on your bank card or statement.
Bursary payments will be paid direct into a student’s bank account only. Please notethat the Collegewill purchasepersonal protective equipment, food cards and allocate some funding for educational visits from the bursary award.
Bank/ Building Society Name:
Sort Code: / / / - / / / - / /
Account Number: / / / / / / / /
Building Society Roll number (if applicable)
8) Declaration by student –please read and sign the declaration below
  • The information I have given on this form is correct, true and accurate to the best of my knowledge.
  • I understand that if I provide false or incomplete information, I may have to repay any money given to the applicant.
  • I confirm that I am not on a Work-Based Learning or Higher Education course
  • I agree to notify the College of any change in my circumstances which may affect my eligibility for funding, or of any change to my course, as soon as either of these occurs, I will inform the Student Services Team immediately.
  • I understand that the College may claim back all or some of the award made to me if I give misleading or inaccurate information intentionally.I recognise that false statements can leave me open to prosecution.
  • I understand that financial assistance is dependent upon satisfactory attendance and behaviour. I understand that if I withdraw from my course early, I may be asked to pay back some or all of the funding I have received to that date.
  • I understand that any funding I am allocated is for this current academic year only and that a new application will be required for any subsequent years /additional courses.
  • I understand that if I am in receipt of any benefits I must declare that I am receiving financial support from the college to any other agencies.

Signed:
(learner applying for assistance)
Signed:
(Parent / Guardian signature) / Date: //
Date: //
7.WHAT HAPPENS NEXT
Please return your completed application form along with all photocopied evidence to:

Alternatively you can email your applications for and evidence to . Please note that sending your application to your centre will delay the process.
You will receive an acknowledgment letter for your application form within 5 working days of the York campus receiving it. If you do not receive this letter, please contact the York office on 01904 772201 or e-mail
Within 15 working days, you should receive a letter, stating the amount of the award and what purchases have been acquired for you from this award.

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