RESIDENTIAL GRANT APPLICATION FORM

2017-18

SECTION ONE - STUDENT DETAILS

Student Number

Mr/Mrs/Miss/Ms

Surname

Forename(s)
Home Address
Post Code:

Telephone No.

Date of Birth
Age as at 31.8.17

Marital Status
Have you been resident at the address above in the UK for 3 years?
Yes/No
If the answer is NO please state previous address and relationship of occupants to you / Centre of Study

Full course title
Duration of course Years
From To
Please tick as appropriate
Full Time Part Time
Please indicate the accommodation the student expects to reside in during 2017/2018
Please tick as appropriate
Type of College Accommodation
En-suite Accommodation
Independent Halls of Residence
Self-Catering
Other (please specify)

The Cost of your accommodation:
SECTION TWO –PARENT/CARER DETAILS
Name and Address of Parents /Carer/Spouse/Partner
with whom the student normally resides
Full name of Adult 1 Full name of Adult 2
(state relationship to student) (state relationship to student)
Address: / Address:
Post Code: / Post Code:

Telephone No.
Occupation of Adult 1 Occupation of Adult 2
( state relationship to student) ( state relationship to student)
Name & Address of Employer:
(During year ended April 2017) / Name & Address of Employer:
(During year ended April 2017)
Post Code: / Post Code:
If you had more than one employer during the tax year ended April 2017, please list further details below.
Name & Address of Employer: / Name & Address of Employer:
Post Code: / Post Code:
SECTION THREE and FOUR
INCOME AND ALLOWANCES FOR THE YEAR ENDED APRIL 2017
The following sections, 3 and 4, should be completed by the parents/step-parents/ carers of the student applying for a grant.
Please enter total gross income from all sources for the year ended April 2017. It is important that under any heading where there is no income the word none is written.
Please complete Income from Benefits if either parents/step-parents/spouses/partners or carers have received any state benefits during the period April 2016to April 2017.
SECTION THREE - INCOME DETAILS
Income source / Examples / Adult 1 / Adult 2
Gross Taxable Salary * / P60 2016/2017 or March payslip 31/03/17.
Business Profits Sole Trader * / Business accounts for 2016-2017 / Tax Return
Business Profits Partnership * / Business accounts for 2016-2017 / Tax Return
Directors Fees * / Business accounts for 2016-2017 / Tax Return
Taxable Benefits, e.g. Car, BUPA, etc. * / P11D 2016-2017 or P2 2016/2017
Spare time and casual work * / *See notes and guidance after Section 6
Pensions - Please give details of each pension * / P60 2016/2017 or letter from Job Centre Plus
Income from Property or letting rooms * / See notes and guidance after Section 6
Bank or Building Society interest on deposits / Please indicate whether you have entered a gross or net figure
Investment/Annuities etc. / Please enter gross amount including tax credits
Any other income
SECTION THREE - INCOME FROM BENEFITS
Please enter details of all benefits you received, except Child Benefit. Please enter the amount you received during the 2016/2017 tax year not the amount you receive weekly, fortnightly or monthly.
Benefit / Adult 1 / Adult 2
Income Support*
Tax Credits*
Job Seekers Allowance*
Housing Benefit*
Care Allowance*
Disability Living Allowance*
Other*
Please state
Evidence of Income and Benefits received
PLEASE ENSURE THATIN ALL CASES WHERE THERE IS AN ASTERISK (*) DOCUMENTARY EVIDENCE IS SUBMITTED. ALL DOCUMENTATION SHOULD BE PHOTOCOPIED CLEARLY.
IF YOU ARE UNABLE TO PROVIDE EVIDENCE OF YOUR INCOME THEN YOUR APPLICATION WILL NOT BE ASSESSED. WE WILL REQUIRE THIS INFORMATION SENDING TO US BY THE END OF JULY AND IF IT IS NOT RECEIVED, IT MAY RESULT IN THE PAYMENT OF THE STUDENT’S GRANT BEING WITHELD.
If you have declared income from benefits please provide either a letter confirming the amount you have received from Job Centre Plus, or from whoever pays the benefit to you, or ask them to complete the enclosed form.
SECTION FOUR - ALLOWANCES
Please enter allowances relating to the year ended April 2017.
Allowances / Example of Evidence / Adult 1 / Adult 2
Retirement Annuities/Personal Pensions *
Do not enter company pensions / Photocopy of original policy or annual statement
Please give details of any dependent children other than the student, including those who will be at school, college or university between 01/09/17 and 31/08/18. Please include a letter of confirmation for student loan or University place.
Income will be halved for families with another child at University and a discount of £1025 will be given for each sibling under 18 years of age.
Name / Date of Birth / School/College to be attended 01/09/2017 to 31/08/18 / Details of any education award granted
SECTION FIVE
STUDENT’S DECLARATION
PLEASE READ THIS SECTION CAREFULLY AND SIGN THE FOLLOWING
This information supplied by me to the best of my knowledge is correct and complete. I undertake to inform Askham Bryan College immediately of any changes in my financial circumstances or of any alterations in the particulars given and to supply any additional information which may be required to verify the facts stated. If a change in my circumstances results in a revised financial award for the academic year then I undertake to repay any amounts overpaid to me back to the College.
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.

Signature of Student Date
SECTION FIVE CONTINUED
PARENTS’ DECLARATION
PLEASE READ THIS SECTION CAREFULLY AND SIGN THE FOLLOWING
This information supplied by me to the best of my knowledge is correct and complete. I undertake to inform Askham Bryan College immediately of any changes in my financial circumstances or of any alterations in the particulars given and to supply any additional information which may be required to verify the facts stated. 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

Signature of parent/ step parent/carer(s) Date

DATA PROTECTION ACT 1998 - The information provided will be used to determine whether financial assistance will be awarded. The College may make enquiries about the validity of the information provided from other central and / or local government bodies, as deemed appropriate by the assessors. The College has a duty to protect public funds it administers and to this end may use the information provided on this form for the prevention and detection of fraud. It may also share this information with other bodies solely for the purpose of administering public funds.
ACCOUNTANT’S DECLARATION
Only have this section completed if this form has been completed by your accountant.
Are the figures declared final figures as submitted to the Inland Revenue for the tax year 2016/2017

YES NO
Signature of Accountant

Date

SECTION SIX
Checklist

  1. Have sections 1-4 been completed fully?
  1. Have the declarations at section 5 been signed as necessary?
  1. Is all the relevant photocopied documentary evidence attached?
Please return your completed form and documents to:
Student Support Services
AskhamBryanCollege
Askham Bryan
York
YO23 3FR
If you need to contact us please call us on telephone number:
01904 772201 / 01904 772222 or email
9.00am to 6pm Monday to Thursday
9.00am to 5.00pm Friday
NOTES AND GUIDANCE
SECTION THREE.
Salary details should be parent’s total taxable pay for the year ended 31st March 2017 as shown on your March payslip. Please remember to enclose copies of payslips dated 31st March 2017 or Form P60 for 2016/2017 as evidence.
Business Profits – if parents are self-employed or in a partnership you need to provide details of net profits for the year end April 2017. If you are unable to provide the exact figures at present you should enter an estimated figure on the form so that a provisional assessment of grant can be made. You will be required to confirm the figures which you have submitted to the Inland Revenue for the year ended April 2017 before the beginning of the term in September 2017.
Director’s Fees or salaries received by either parent as a director of his/her own or any other company should be entered here. If this figure is estimated a form will be sent to you in due course and you will be required to confirm the figures which you have submitted to the Inland Revenue for the year ended April 2017.
Taxable Benefits include Car and Fuel Benefit, BUPA subscriptions etc. received in the course of employment. Please enclose a P11D for 2016/2017 or P2 for 2016/2017.
Pensions include all taxable pensions such as State Retirement Pensions, Widow’s Pensions and pensions from employers. A form P60 2016/2017 or a letter from Job Centre Plus should be enclosed as evidence. Pensions from employers for dependent children should also be entered here unless that pension id paid direct to the child.
Income from Property/Letting/Accommodation needrent book or evidence of rent received.
Bank or Building Society interest earned on deposits should be entered as a gross amount for the year ended April 2017.
Investments which have paid dividends during the year ended April 2017please enter the amounts here, including tax credits.
SECTION FOUR
Retirement Annuities or Personal Pensions can only include private or personal pension premiums only. Do not enter Superannuation contributions made through your employment. Please send copies of the policies as evidence.
THE AUTHORITY RESERVES THE RIGHT TO REQUEST DOCUMENTARY EVIDENCE WHICH HAS NOT BEEN REQUIRED PREVIOUSLY, SHOULD IT BE CONSIDERED NECESSARY.

MS/17/5/1