For Part Time Students on Undergraduate and Postgraduate Courses

Access to Learning Fund 2011/12 Application Form

For Part Time Students on Undergraduate and Postgraduate Courses

You should read the accompanying guidance notes whilst you complete this form. They will help you ensure that you fill out the form correctly and include all the evidence you need. Your application will be delayed if you do not follow the guidance notes carefully.

CONFIDENTIALITY: Applications are seen only by Student Financial Support and Student Information Point staff. It may be necessary for additional supporting information to be sought from other University staff in order to reach a decision on your application.

Where you see the reference indicates the section you should refer to in the

guidance notes. For example = Section One, Paragraph 5.

Part 1: Personal details

First name(s)

Surname or family name

MMU Student ID Number Date of birth

Full address, including post code

All letters will be sent to this address.

You must inform us if you move

or require anything sent to an

alternate address.

Mobile phone number

MMU email address

Do you have any children who are financially dependant on you? Yes No

Are there any adults who are financially dependant on you? Yes No

Tick all that apply:

I am single I live with my spouse/partner I am a lone parent

I live with my parents I live alone or with other independent adults

For office use only Date received:

E mail sent to student acknowledging application is complete

on date: initials:

Received via: SIP int mail ex mail email other

Part 2: What course are you on?

Course title

Course leader/tutor

What level is your course? Undergraduate PG Number of weeks

What year are you in? e.g. 1, 2 Is this a repeat year? Yes No

How many units are you studying this year? And how many credits is this?

Mon / Tues / Weds / Thurs / Fri
Morning
Afternoon
Evening

How many days or evenings

are you required to attend

each week?

Using the grid, indicate

the number of hours you

attend for each session

Confirmation of course details

To be completed by your course tutor or programme leader.

I confirm the number of units and credits the above named student is studying during the academic year 2011/12 to be: Units Credits

------

Signed Date

------

Print name Email Extension

Part 3: Your bank or building society

This will be the account we pay into should you receive an award from the Fund. We can only make payments into an account bearing your name. Please read the guidance notes for this section carefully.

Name of bank/building society in BLOCK CAPITALS

Name of account holder in BLOCK CAPITALS

Sort code Account number

Have you received a payment from the University into this account before? Yes No

For office use only Enrolled SAP checked Initials

o/s EHL Year of EHL

Previous award from ALF: Yes No Bank details – New Same Different

Details

Part 4: Your income and expenditure

Please provide weekly figures except where indicated.

Your income You & your partner’s expenditure

Professional and Career Tuition fees

Development Loan (postgraduates) If you pay them yourself

Net earnings Childcare costs

Disabled Students’ Allowance (DSA) Travel costs

To and from the university during term

Disability Benefits (excluding DSA) Course costs

Please specify Books, equipment, photocopying, etc.

Tax credits Disability costs not covered the DSA

Please specify

Benefits

Partner’s income

Other income including savings

Net earnings

Net earnings

Please specify Other

Please specify

Annual income

Please provide total figures for the year:

Tuition Fee Grant

Undergraduates only

Course Grant

Undergraduates only

Part 5: Your supporting statement

You must submit a supporting statement outlining the reasons for your application.

Please continue on a separate sheet if necessary.

Part 6: Declarations

I certify that, to the best of my knowledge, I fulfil the following criteria:

UK national students must answer (a) and (c). All other students must answer all sections.

(a)  I am a UK National. If YES, go to (c)

I am an EU National.

There are no restrictions on my stay and I am therefore settled on the first day of the first academic year of my course within the United Kingdom (UK); i.e. I have the Right of Abode in the UK or have Indefinite Leaver to Enter/Remain (ILE/R in the UK).

I have been recognised by the UK Government as a Refugee and have Full Refugee Status/ILE/R as a result.

I have Exceptional Leave to Enter/Remain in the UK/Humanitarian Protection/Discretionary Leave (ELE/R/H P/DL).

I am an EEA or Swiss Migrant Worker.

I am the spouse/child of an EEA Migrant Worker, Swiss employed person, Swiss national or Turkish Worker.

If you are an EEA Migrant Worker or Swiss employed person, do you Yes intend to continue working while studying?

No

(b)  I have been ‘ordinarily resident’ within the UK and Islands for 3 years immediately before the start of my course. (Anyone with ELE/R/HP/DL or anyone recognised by the UK Government as a Refugee should have maintained ‘Ordinary Residence’ from the date this status was granted.)

None of this time was wholly or mainly for the purple of receiving full time education, or if it was I was resident in the EEA immediately prior to this 3 year period.

(c) I confirm that I am supporting the children named in the application.

I confirm that I am not living with a spouse/partner.

I confirm that I am registered and in attendance on the course described in Part 2 of this form.

I declare that the information I have given on this form is correct and complete to the best of my knowledge.

I understand that giving false information will automatically disqualify my application and may also lead to disciplinary procedures resulting in possible expulsion from the University and the repayment of any monies obtained by me as a result of giving false information.

I agree to inform the Student Financial Support Unit if there are any changes in my circumstances.

Your name in CAPITALS (do not type) Your signature Date

Final page - nearly there, just need to check you’ve done everything.

Before you submit your application, look at the list below. Have you included everything? If not, remember your application will be delayed. Have you signed your form?

Tick what information you are including

I have answered all the questions. I have attached all the documents asked for

I have signed and dated the declaration. I have read and kept a copy of the guidance.

notes

I have attached copies of my… (tick all that apply to you)

Fee and Course Grant Notification Professional and Career Development

Undergraduate students only Loan agreement or other income source

Postgraduate students only.

Tuition fees payment plan or receipt Complete award notice for any means-

If you are paying your own fees tested benefits claimed

Partner’s income and expenditure Childcare costs – receipts or invoice

Indicating regular weekly/monthly amount paid

Complete award notice for Child Tax

Credit/Working Tax Credit – all pages

Tell us how you first heard about the Access to Learning Fund

MMU Website Other website Tutor/Programme Office

MMU Advice Centre Poster Advert Other: (please specify)

For office use only: Documents seen by SFSU staff:

Where to send your form

Your completed form, together with all relevant supporting documents as shown, should be posted to:

Student Financial Support Unit,

Student Services,

Student & Academic Services,

Manchester Metropolitan University,

All Saints Building,

Oxford Road,

Manchester M15 6BH

Data Protection Act 1998 www.mmu.ac.uk/policy/

Manchester Metropolitan University is a data controller in terms of the 1998 legislation. Student Services follow University policy in matters of data protection. The data requested in this form is covered the notification provided by the University under the Data Protection Act. Personal data will be used solely in the department for statistical purposes and electronic records 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 enquired concerning the use of data noted here should be addressed to the Assistant Director of Student Services (Student Administration).