Access to Learning Fund Application Form

Please read before completing this application form

  1. The Access to Learning Fund provides discretionary financial support that cannot be met by other sources of support for students. It is aimed at students who have a sudden financial emergency or face financial problems during their course. To apply, students must have full funding in place and be able to provide a copy of their Financial Notification Letter and payment schedule. Please refer to the Guidance Notes for eligibility criteria. If you have not yet received notification of your student finance, please contact the Welfare Information Point to request details about applying for a short-term Emergency Loan.
  1. Please provide photocopies of all evidence required as failure to do so will result in a delay in processing your application. Originals will not be returned. Take your completed application form and photocopied evidence to Student Welfare in Binks, room 1.13 at Chester campus or Student Welfare in Martin, room 0.12 at Warrington campus. Students based at Clatterbridge should send their application to Warrington campus, students based at Leighton should send their application to Chester campus.
  1. You should be informed of the outcome of your applicationthrough your student e-mail accountwithin four weeks, provided that you have enclosed all of the required evidence. Therefore, please check your University e-mail regularly. No other email account will be accepted.

Chester Campus / Leighton / Warrington Campus / Clatterbridge
Student Support Funds Officer
Student Support & Guidance
Binks 1.13
University of Chester
Parkgate Road
Chester
Cheshire
CH1 4BJ
Tel: 01244 511550
e-mail: / Student Support Funds Officer
Student Support & Guidance
Martin 0.12
University of Chester
Crab Lane
Warrington
Cheshire
WA2 0DB
Tel: 01925 534282
e-mail:

Name:

Student No:

Date Received:

(For Office Use Only)
PART 1 – Personal Details

PART 2 – Dependants

Do you have any children who are financially dependent on you? If yes, please complete this section. If no, go to Part 2a.

Child’s Full Name / Date of Birth / Relationship to you / Do they live with you?

Access to Learning Fund Application Form 2011/12 1

PART 2a – Dependants continued

Do you have any adults who are financially dependent on you? If yes, please complete this section and provide evidence as requested in the Guidance Notes. If no, go to Part 3.

Full Name / Age / Relationship to you / Reason they are financially dependent on you

PART 3 – Disability / Special Medical Needs

Do you have a disability or chronic medical condition? If yes, please complete this section. If no, go to Part 4.

PART 4 – Course Details

Part 5 – Part Time Students ONLY

You must be studying at least 50% of an equivalent full time course. Disabled students, whose disability prevents this, are eligible if studying at least 25% of a full time course. You must provide confirmation and evidence of this. You must also have applied to your funding provider for both the fee and course grant.

Part 6 – Full Time Students ONLY

Part 7 – Income Per Week Per Year Additional Information Office

NHS Bursary
Maintenance Loan
Maintenance Grant
Special Support Grant
Adult Dependants’ Grant
Childcare Grant
Parents’ Learning Allowance
University of Chester Bursary
Scholarships/Trusts
Fee Grant (part-time students only)
Course Grant (part-time students only)
Job seekers Allowance
Income Support
Disability Benefits (please specify) / Only include payments made to your bank account. Do not include payments made directly to a supplier
Housing Benefit
Child Tax Credit
Working Tax Credit
Child Maintenance/CSA Payments
Pension (please specify type)
Partner’s Net Earnings (after tax & NI)
Parental / Partner Contribution / Please read part 7 in guidance for more information
Other Income not included here / e.g.from property rental, share dividends
Savings / Include all savings, even those you do not have immediate access to e.g. ISAs. You will need to provide evidence
Postgraduates ONLY
Career Development/Prof Study Loan

Part 8 – Your Expenditure

If you live with a partner you must declare joint expenditure.

Per Week Per Year Additional Information Office

Tuition Fees (part time UG students only)
Rent/Mortgage/Halls Fees (if non- catered) / Proof of tenancy/mortgage. Please read part 8 in guidance for more information
University Halls Fees (if catered) / Proof of tenancy. Please read part 8 in guidance for more information
Council Tax (if applicable).Please state why you are not exempt / Most full time students are not liable for council tax. If you are paying, please provide evidence i.e. copy of your 2011/12 bill
Food/Household/Laundry /
Utilities (gas, electric, water etc)
Broadband/Phone/ TV Licence / Known as Composite Living Costs. Please read part 8 in guidance for more information
Mobile Phone
Clothes/Entertainment
Contents Insurance
Disability Costs not covered by DSA
Childcare Costs / Please read part 8 in guidance for more information
Life Insurance(if you have children) / Please read part 8 in guidance for more information
Private Vehicle Costs (not fuel) / Please read part 8 in guidance for more information
Car Finance / Please read part 8 in guidance for more information
Travel: Term time / To university/placements
Travel: Family / Visits to family, not holidays or leisure
Travel: Work / Only if in addition to term time or family
Travel: Other / Please specify
Course Costs (books, equipment, field trips etc, not tuition fees) / Please read part 8 in guidance for more information
Personal Loans/Debts/Credit Cards / Give minimum weekly payment & provide evidence. Please read part 10 for further help with debts
Other Costs / Please specify

Part 9 – Bank/Building Society Details

You MUST enclose photocopies of the last three months’ statements for all current and savings (inc ISA) accounts for yourself and your spouse/partner if applicable.Please note: mini-statements are not acceptable. You MUST explain all credits and withdrawals of £100 or more.

Name of Bank/Building Society / Overdraft Limit / Current Balance / Credit or Overdrawn

Part 10 – Debts

Priority debts

Child Poverty Action Group’s ‘Debt Advice Handbook’ explains priority debt as: “those where non-payment would give the creditor the right to deprive the debtor of his/her home or essential goods and services”.

Non–Prioritydebts

The ‘Debt Advice Handbook’ explains non-priority debt as: “those where non-payment will not result in the loss of the debtor’s home, liability, essential goods or services”.

Non-priority debts such as credit cards cannot be used as part of your Access to Learning Fund application. However, it would be helpful for us to know what these debts are so we may gain a more accurate picture of your overall financial situation.

Only those debts that have been ‘managed’, i.e. repayment arrangements have been agreed and the source of credit is no longer available,should be included in your Access to Learning Fund application form. Please indicate the total outstanding debt and your weekly/monthly repayments. You MUST include evidence of the debt and of your Repayment Plan showing your regular payments.

Access to Learning Fund Application Form 2011/12 1

Part 11 – Supporting Statement

State why you are in financial difficulty, and why you believe your situation to be exceptional and to merit additional support.

Include explanations for high expenditure, emergency expenditure or low income.

Examples:

If you need a car because you are required to undertake placements where public transport is not adequate, give details of the location, times and duration of the placement.

If you have caring responsibilities for a relative and this means you travel home frequently, give details of the frequency and distance of visits and the care you provide.

If your parents/guardian/partner do not provide the funding they have been assessed to contribute, because of exceptional circumstances, please give details of these circumstances along with a supporting letter from your parents/guardian/partner to confirm their situation.

If you are unable to work because of ill health, disability or because you have children, give details. Any evidence you can provide in support of your statement may help your case.

Part 12 – Payment Details

Please confirm your bank details to enable payment to be made directly into your bank account
Bank:
Sort Code:
Account Name:
(e.g. J & M Smith)
Account Number:
Reference Number:
(for Building Society Accounts)
There is an expectation that students will have opened a student bank account with overdraft facility before making an application to the Access to Learning Fund.
If you do not have a student bank account, please provide an explanation.
T

Part 13 – Evidence Checklist

You MUST provide photocopied evidence wherever relevant to youOffice







/ Rent/Mortgage/Halls: If you pay rent you must provide proof of tenancy and cost, clearly showing the regular sum due and period of contract. If you pay a mortgage you must provide the mortgage agreement or the latest notification of monthly payments. These must detail the payments due.
Council Tax: If you pay council tax you must provide a photocopy of your 2011/12 bill and explain why you are not exempt.
Student Loan confirmation: You need to provide your Financial Support Notification and your Payment Schedule letter / Loan Request Form.
Other Student Financial Support notifications: You must provide a copy of your official notification letters, e.g. NHS Bursary; Fee and Course Grant (for part time students); Professional and Career Development Loan.
Enrolment Form/Student Status Letter: You must provide a copy of the official letter issued to you when you enrolled at the beginning of this academic year.
Bank/Building Society statements: You must providephotocopied statements for all current and savings (inc ISA) accounts that you (and your partner) hold. TheyMUST cover the last three consecutive months and you MUST provide an explanation for any withdrawals or credits of £100 or more. If your overdraft limit is not printed on the statements please write this on.
Tax Credits and Benefits: If you receive any of these you must provide a photocopy of the full assessment notice.
Students with children: You must provide photocopies of birth certificates or your child benefit assessment notice. If you are paying childcare costs, you must provide photocopies of the last three months’ invoices along with photocopied evidence of actual payments.If your childcare costs are variable, please submit a letter from your childcare provider to confirm the average monthly cost. If your child has special needs you must provide evidence.
Student ID: You must enclose a photocopy of your student ID.
Residency status: You need to provide photocopied evidence of your EU ‘home’ residency
Income: You must provide evidence of your income (part time undergraduate and postgraduate students only) and evidence of your partner’s income.
Other income: You must provide photocopied evidence of any other income e.g. earned from property rental, share dividends etc. /

Confidentiality

Applications are seen by the Access to Learning Fund Panel and Student Welfare staff. It may be necessary however for additional supporting information to be sought from the university staff in order for the Panel to reach a decision. By signing the Declaration in Part 13 you are granting permission for us to share your information with other university departments.

Data Protection Act 1998

The University of Chester is a data controller in accordance with the 1998 legislation. Student Support and Guidance follows university policy in matters of data protection. Any formal enquiries concerning the use of data noted here should be addressed to the Senior Welfare Officer.

Part 13 – Declarations(tick all that apply)

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

I am a UK National

I am a EU National

There are no restrictions on my stay and I am therefore *settled within the United Kingdom (UK). (Have the right of abode in the UK or have Indefinite Leave to Enter/Remain (ILE/R) in the UK)

I have been recognized 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 Migrant Worker or Swiss employed person.

I am the spouse of an EEA Migrant Worker or Swiss employed person.

I I am the 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, please state whether you intend to continue working whilst studying.

w

*settled – on the first day of the first **academic year of your course.

**academic year – means the period of 12 months beginning 1 September (if course starts on/after 1 September)

Part 13 – Declarations continued (tick all that apply)

PLUS

I have been ‘Ordinarily Resident’ within the UK and Islands for three years immediately before the start of my course. (Anyone with ELE/R /HP /DL or anyone recognized 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 purpose of receiving full time education or, if it was, I was resident in the EEA immediately prior to this three year period.

AND

I confirm that I am supporting the child/children named in section 2.

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 4 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 failing to disclose all relevant information and/or giving false information will automatically disqualify my application and may also lead to disciplinary procedures resulting in possible expulsion from the university.

I further undertake to repay any loans / grants obtained by me as a result.

Your signatureDate of application

Access to Learning Fund Application Form 2011/12 1