APPLICATION FOR A GRANT 2016/17

Last Name ………………………………… First name …………………………… Title Mr/Mrs/Miss/Ms

Home address ……………………………………………………………………………………………… Postcode ……………….

Tel No ………………………………… Email ………………………………………………………………………………

Age at 31/08/2016 …………… Date of Birth …………………… Nationality ………………………………

What course have you applied for? ……………………………………………………………………………..

Have you been resident in the UK/EU for 3 years prior to 31/08/16 Yes □ No □

Are you enrolled on a course through Jobcentre Plus? Yes □ No □

Is your course eligible for an Advanced Learning Loan? Yes □ No □

Please tick the box that applies to you and supply only the corresponding evidence.

□ I am aged 16-18 at 31/08/16 and live with my
parents/guardians
We need to see your PARENTS’ income /
  • 2016/17 Tax Credits Award – all pages

□ I am aged 16-18 at 31/08/16 and live
independently
We need to see YOUR income /
  • Income Support/Universal Credit letter or
  • ‘In Care’ letter from Local Authority or
  • ‘Care Leaver’ letter from Local Authority or
  • ESA and DLA/PIP letters

□ I am aged 19 or over at 31/08/16 and live with
my parents/guardians
We need to see YOUR income /
  • Benefits letter (dated after April 2016) or
  • Last 2 Wage Slipsor
  • Bank statement (only if you have no income)

□ I am aged 19 or over at 31/08/16 and live with a
partner
We need to see income for YOU AND YOUR
PARTNER /
  • 2016/17 Tax Credits Award or
  • Benefits letter (dated after April 2016) for you both or
  • Last 2 Wage Slips for you both

□ I am aged 19 or over at 31/08/16 and live
independently
We need to see YOUR income /
  • 2016/17 Tax Credits Award or
  • Benefits letter (dated after April 2016) or
  • Last 2 Wage Slips

If you are applying for a bus pass, please provide 3 passport photos with this application form.

□ Bus □ Train □ Car □ Taxi provided by local authority □ Private taxi □ TCAT Coach □ Walking

We will only consider a contribution towards taxis in exceptional circumstances. We will need a letter explaining why you need a taxi, plus supporting evidence eg a doctor’s letter.

We will try to award you payments for other expenses eg kits, uniforms, books, where funds allow.

You will be awarded free meals if you have submitted the qualifying income evidence (see booklet)

If you are applying for childcare funding, you will need to complete a separate form.

PLEASE READ THE CONDITIONS ON THE BACK OF THIS FORM AND SIGN TO SAY YOU AGREE

By signing this agreement I declare that:

  • I understand that if I have submitted false evidence or fail to tell College about any income which is relevant, the matter may be referred to the Department of Education or the police.
  • I understand that it may take up to 15 working days to process my form during busy periods.
  • I understand if I do not submit my application form at least 3 weeks before the start of my course, I will have tofund my own travel until the relevant travel passes arrive (this also applies if I have enrolled late). College will not be held responsible for passes arriving late from Arriva/Local Council.
  • I understand that a target of 100% attendance is required at all lessons.
  • I must abide by College rules and understand that punctuality, behaviour to all staff/students, and course commitment are taken into account when my payments are being made.
  • I understand that it is my responsibility to inform grants staff in Learner Services if I have been absent so that my payments may still be made – contact 01952 642523.
  • I understand that I must submit any queries I may have about payments within 4 weeks of the payment date. Missed payments any more than 4 weeks old will not be paid.
  • I understand that if I withdraw from College, I must return any travel passes/uniform or equipment that I have received funding for. If they are not returned within a reasonable time, I may be required to repay the College for the value of these items.
  • I understand if a payment is withheld for any reason and I disagree with the decision, I may appeal by completing an appeals form. I can also appeal if my grants application is refused by writing a letter to the Head of Learner Services within 14 days of the refusal date.

All grants will be either be given in kind or paid directly into your bank account. Please supply details of your account for payments to be made*
Name of bank ……………………………………………………………………………
Bank address ……………………………………………………………………………
Sort Code ……………………. Account Number …………………………….
Name of account holder …………………………………………………………… / *The bank account must be in your name. We will not pay into someone else’s account unless there are exceptional circumstances. If you do not have a bank account, please speak to Grants staff.

I can confirm that I have read and understood the above:

Student Signature: ……………………………………………………………………………..

Student Name: (please print) …………………………………………………………….

Date: ………………………………