Student Assistance Fund 2017/2018

STUDENT ASSISTANCE FUND 2017/2018

The Student Assistance Fund is co-funded by Irish Government and European Union under the European Social Fund Human Capital Investment Operational Programme 2014-2020 – ‘Investing in your Future’
Incomplete applications will not be considered.
Return your completed SAF 2.2form and supporting documents to SAF Administrator, Student Advice Centre, Henry Grattan Building, Glasnevin Campus, Dublin City University, Dublin 9

SAF Administrator, Student Advice Centre, Henry Grattan Building, Glasnevin Campus,

Dublin City University, Dublin 9 - Queries to:

Childcare Application Form

To Be Completed By Student

Student Name: / Student Number:
CHILDCARE ASSISTANCE
Name of Children in Childcare / Creche/Childminders Name
1. / 1.
2. / 2.
3. / 3.

Notes:

If there is a family breakdown or extenuating circumstances and you are under 23 and financially independent, please advise this office.

In the case of separation/divorce or a death of a parent/guardian and you are unable to provide income details, please provide evidence of the situation. E.g. copy of separation papers, copy of death certificate.

All students must submit supporting documents to supplement their online application.

Childcare Documents – Please provide the following:

Birth Certificate of Child
Letter from Childminder or Creche confirming registration of child and amount per week.

Section 1: Personal Details (Part 1) – To be completed by all applicants

*Please tick box or complete in capital letters where applicable

Name / Student No:
Mobile: / DCU Email:
Gender: / Age Group: / 15 – 24 / 25 - 64
Programme: / Programme Type / Undergrad F/t / Undergrad P/t / Postgrad F/t / Postgrad P/t / PhD
Year / 1 / 2 / 3 / 4 / Repeat Student / Yes/No / Semester 1
Semester 2
Fees 2017/2018 / Free Fees / EU Fees / Non-EU Fees
Country of Origin / Are your fees paid in full? / Yes / No / Amount

Personal Details (Part 2)

Are you financially dependent? / Yes / No / If yes, are your parents/guardians/partner in receipt of social welfare? / Yes / No
Have you received the Student Assistance Fund in previous years? / Yes / No
2013-2014 / 2014-2015 / 2015-2016 / 2016-2017
Have you been admitted to DCU via Direct Entry? / Yes / No
HEAR / ACCESS / Mature Student / Disability Service / Combination
Indicate Living Arrangements: / Renting On Campus / Renting Off Campus / Parents/Guardians Home / Own Home
How did you become aware of the Student Assistance Fund?
Pre-Entry Status: / Full-Time Education / Employee
Self-Employed / Unemployed (less than 12 mths) / Unemployed (more than 12 mths)
Pre-Entry Qualification: / Leaving Cert / Inter/Junior Cert
Third Level / Other Qualification

Required by the HEA for statistical purposes. All information provided is strictly confidential

Section 2: Student’s Income (Answer yes or no and give details)

Are you in receipt of a SUSI Grant? / Yes Fees Only / Yes Maintenance Only / Yes Fees Plus Maintenance / No
Amount per month / Top Up? / Amount per month
Are you in receipt of Social Welfare for 2017/2018? / Yes / No / Type
Are you in receipt of any grants, bursaries, awards or scholarships other than the maintenance grant? / Yes / No / Amount
Donagh O’Malley Scholarship / McManus Scholarship / DES Gaelteacht Scholarship / Bank Scholarship
Credit Union Scholarship / Trade Union Scholarship / Sport Scholarship / Other
Are you engaged in part-time work? / Yes / No / Amount per week/once-off payment / Occupation

COMPULSORY

Section 1: Partner’s/Parent’s/Guardian’s/Spouse’sIncome Details

Occupation Spouse/Guardian 1/Parent 1 / Amt per week/month/year?
Occupation Partner/Guardian 2/Parent 2 / Amt per week/month/year?
Other Income / Amt per week/month/year?
No. of dependent children / No. of children in higher education

Section 2: Student’s Annual Budget *

Academic Year - *Multiply monthly incomings x 9 ormultiply weekly incomings x 36

Income - 9 Months / (€) / (€)
SUSI / € / Carers Allowance / €
Scholarship/Bursary/Award, etc. / € / Health Board Payments / €
Allowancefrom parents/guardian / € / Charitable Support / €
Allowance from partner/spouse / € / Childcare Support / €
Lone Parents Allowance / € / Maintenance Support / €
Back to Education Allowance / € / Income from Employment / €
Disability Allowance / € / Access Grant / €
Rent Allowance / € / Summer Work Savings / €
Family Income Supplement / € / Other / €
Total Income
Expenditure - 9 Months / (€)
Rent/Mortgage / € / Childcare / €
Daily Transport to College / € / Car Tax / €
Transport at Weekends / € / Car Insurance / €
Gas/Electricity/Oil / € / Medical Insurance / €
Groceries/Food / € / Extra-Curricular Activity / €
On/Off Campus Meals / € / TV Licence / €
Internet / € / Bin Charges / €
Phone/Mobile / € / Water Charges / €
Medication / € / Other / €
College Books / €
College Materials / € / Total Expenditure

Reason for applying

______

Section 3: Supporting Documents

Student’s under 23 on January 1st, 2017

Supporting Documents
Provide the relevant documentation for A, B or C (for parents/guardians) / √

PAYE - P21 or P60 for 2016

Welfare - Social Welfare Statement for 2016

Self Employed - Notice of Assessment for 2016

Grant Applicants
Copy of letter from SUSI confirming grant for 2017/2018 / √
All Applicants
2 months bank statements (student) / √
Copy of student card / √

(Note: If you have applied for a SUSI grant you do not need to provide proof of income. However, if you are declined your SUSI grant you will be asked to provide proof of income)

Student’s over 23 on/before January 1st, 2017

Supporting Documents
Provide the relevant documentation for A, B or C (for student and/or partner) / √

PAYE - P21 or P60 for 2016

Welfare - Social Welfare Statement for 2016

Self Employed - Notice of Assessment for 2016

Grant Applicants
Copy of letter from SUSI confirming grant for 2017/2018 / √
All Applicants
2 months bank statements (student) / √
Copy of student card / √

If your family income is over the threshold but changes have occurred in 2016, please provide evidence of the following as well as the above.

Supporting Documents
Choose one from A, B or C / √

Social Welfare Receipts

Last 3 months payslips

You may be required to provide further supporting documentation at a later stage

SAF 2.2 / Childcare Application Form