Please complete this form in full and return it within 2 weeks to:Nicki Berezny, Ruskin College, Dunstan Road, Old Headington, Oxford OX3 9BZ

ALL ORIGINAL SUPPORTING EVIDENCE must accompany this application form.If you would like to come into the College so you original documents can be copied please ring 01865 759781 to arrange an appointment time.

  1. YOUR DETAILS

Have you previously attended any courses at Ruskin College? No / Yes

Do you already have a Level 3 qualification? No / Yes

Gender: Male / Female / Title:
First name: / Family name:
Current home address:
Postcode: / Other addresses in last 5 years (continue on a separate sheet if necessary):
Email address: / Telephone numbers
Mobile:
Home:
Date of birth: / National Insurance Number:

NOTES FOR COMPLETING SECTION 2: INCOME ASSESSMENT

1Complete this financial information if you live at the same address with another adult (i.e. married or in civil partnership or live together as if married or in civil partnership)

2Complete this financial information if you live at the same address as your parent(s). If the parent you live with has remarried, lives with a partner or has entered into a civil partnership, please also give information about their income.

3Include gross interest on savings, investments and dividends (including interest from any bank or building society). Enter the gross amount (before tax is taken off). Do NOT include Individual Savings Accounts (ISAs) or other tax free investments. Include the full amount of any “chargeable event gain” from a life insurance policy.

4Include income from property or land in the UK that you let. Do NOT include income from the “rent a room” scheme (if you let a furnished room in your home for £4,250 a year or less)

5DO NOT include the following (non taxable) benefits:

  • Child benefit
  • Child tax credit
  • Council tax benefit
  • Disability living allowance
  • Guardian’s Allowance
  • Maintenance payments from former partner
  • Maternity Allowance
  • Pension Christmas bonus
  • Student loans or grants
  • Tax free savings income
  • Universal Credit
  • War pensions
  • Winter Fuel Payment
  • Working Tax credit

Include the gross amount of any personal pension contributions you paid into a registered scheme – do not include pension contributions paid through your employer

2.INCOME ASSESSMENT

The purpose of this part of the form is to obtain a clear estimate of your income and that of your household. Please enter your CURRENT ANNUAL INCOME before deductions of tax and national insurance contributions:

YOURSELF
(£) / SPOUSE/
PARTNER
(NOTE 1)
(£) / PARENTAL INCOME
PARENT 1
(£) / Parent 2,
(NOTE 2)
(£)
INCOME FROM EMPLOYMENT / Earnings from all jobs before taking off Tax and National Insurance
Total self employment income
OTHER INCOME / Income from Savings and Investments
(Note 3)
Income from Property (Note 4)
Income from Trusts
State Pensions
Occupational or Personal Pensions
Any Other Income
BENEFITS
(NOTE 5) / Carer’s allowance
Contribution based Employment and Support Allowance
Contribution based Jobseeker’s Allowance
Incapacity benefit – short term higher rate (Note 6)
Incapacity benefit – long term higher rate (Note 6)
Bereavement allowance
TOTAL ANNUAL INCOME
LESS PERSONAL PENSION CONTRIBUTION PAID (Note 7)
NET INCOME

PLEASE ENCLOSE EVIDENCE OF ALL INCOME AS FOLLOWS:

Earnings from employment:The last 3 weekly/monthly payslips

Self employment: Self Assessment Tax calculation for 2014/15

Savings and investments: Tax Return/Investment Statement (as appropriate)

Benefits:Benefits Award notice/ letter from Department of Work and Pensions

DECLARATION I declare that all information and any evidence in support of this application is correct and complete to the best of my knowledge and belief

______(student)

______(spouse/partner)

______(parent(s)/stepparent/partner living with parent

6

  1. OTHER ALLOWANCES

Please fill in this part if you have a person who financially depends on you or if you have dependent children.

Additional allowances can be paid, providing your and your family income is under certain financial limits, as follows:

a.Adult Dependent Grant

If you have an adult in your household who depends on you financially then you can claim for an Adult Dependent Grant, if:

  • You are married to or in a civil partnership with that person
  • You live with a person and are25 or over
  • You cannot claim for an adult who is a student in receipt of a statutory award
  • You can only receive one grant even if you have more than one adult who is dependent on you
  • You are non-resident student

If you wish to claim this grant please complete the following information for the adult:

Their full name
Their date of birth
Their relationship to you
Their address

Please provide appropriate evidence for this – birth certificates and marriage certificates, etc

b.Parents Learning Allowance and ChildcareSupport

If you have dependent children then you can claim for both a Parents Learning Allowance and also support towards childcare costs

A Parents Learning Allowance, which is to help with course-related costs, such as books and stationery, can be paid if you have one or more dependent children.

To be eligible for Parents Learning Allowance:

  • Your child(ren) must live with you
  • They must be under the age of 19
  • You do not have to be using childcare to claim for the Parents Learning Allowance
  • You are non-resident student

If you have dependent children and wish to claim for a Parent’s Learning Allowance and/or Childcare Support please complete this section:

Please give details of children totally or mainly financially dependent on you during the academic year 2015/16.

Please enclose the birth certificate for each child together with your Child Tax Credit notification and Child Benefit notification.

We will send you a separate form if you wish to claim the costs of your childcare. However please note that you can only apply for childcare support if:

  • You are a non-resident student
  • If you have dependent children under 15 at the beginning of the academic year (or under 17, if they have special educational needs) and you need childcare services for them
  • If you your husband, your wife or your partner DO NOT receive, or expect to receive, the childcare element of the Working Tax Credit
  • For registered or approved childcare.

Child 1 / Child 2 / Child 3 / Child 4
Childs full name
Address
Date of Birth
Who will the child live with during your course?