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EFSA Bursary

Crypt School Application Form 2017-18

The 16–19 Bursary Fund Scheme has been set up by the Government to support less well-off students who wish to studyin the academic year 2017-18. There are two types of Bursary:

  • A guaranteed vulnerable group bursary that is set at £1,200 for a full time student and pro-rata for part-timers
  • A discretionary bursary that is tailored by the institution to meet an individual student’s needs

The guaranteed bursary for defined vulnerable groups are:

  • Young people in care
  • Care Leavers-includes those students who have a Special Guardianship Order granted
  • Young people receiving Income Support or equivalent Universal Credit in their own right
  • Disabled young people receiving Employment Support Allowance AND Disability Living Allowance (or Personal Independence Payment-PIP) in their own right

Other eligible groups:

  • Unaccompanied asylum seekers (UASC) are treated as being in care
  • A young person placed with a foster carer by a local authority

No other Groups are eligible

Applicants should be aware that The Crypt School is only allocated a finite amount of money for discretionary bursaries and that this will be distributed amongst applicants in relation to their priority levels of eligibility. Once this money has been allocated there will be no more money to distribute. The funding comes to the school from central government and the school has no other money to pay bursaries.

Please be aware that you need to complete all necessary sections of this form and provide evidence of ALL household income in order to be considered. Please submit photocopies of evidence of any declared benefits or income (or bring the original documents to school, where we will be happy to photocopy them for you).

Assessing Eligibility-age

To be eligible to receive a bursary the student must be aged:

  • Over 16 and
  • Under 19 at 31August before the academic year in question.

If a student turns 19 during their programme of study, they can continue to get the bursary to the end of the academic year in which they turn 19, or to the end of the programme of study, whichever is sooner

A documentoutlining the Bursary Scheme in greater detail is available from the Sixth Form Office.

If you need help in completing this form you should contact the Sixth Form Office.

Student Personal Details
Name:
Tutor Group:
Date of Birth:
Address:
Postcode:
Telephone No.:
Email Address:
National Insurance No.:
A-Level Courses:
Student Personal Circumstances (all applications are treated in the strictest confidence) / Yes / No
Are you in Local Authority Care, a care leaver, or living with foster parents?
Are youin receipt of income support?
Are you in receipt of Employment Support Allowance AND Disability Living Allowance?
Do your parents / guardians receive any of the following benefits? / Please tick / Amount per week
Universal Credit
Income Support/Job-Seekers Allowance:
Employment Support Allowance or Disability Living Allowance?
Child Tax Credit:
Working Tax Credit:
Are you in receipt of Free School Meals?
Other income-based benefit (please specify):
If you live with, or are financially dependent upon, your parent(s) or guardians(s) and the totalHOUSEHOLD income (i.e. of all adults who contribute) is below £25,000 please provide details below: / Amount per annum
Name:
Name:
Name:
Address
(if different
from yours):
Their combined annual earnings (including benefits):
You must submit proof in the form of notification from Benefits Agencies or a P60 for ALL adults in this category, Tax Credit Award Notices, Universal Benefit notices, pensions, certified letters from the Local Authority confirming student entitlement to Free School Meals, or evidence of self-employed earnings. If these documents are not available, please supply 3 months of bank statements.
Financial Assistance Required
(Provide Specific Details Below) / When (Date)? / Subject (course) / Cost / Approved (yes/no)
Materials, books or resources (further to those already provided by the school):
Educational trips / visits:
Exam or registration fees:
UCAS / CUKAS fees:
Transport:
Other (please specify):
Student Declaration
I certify that the information I have provided is correct and that I can provide supporting evidence. I understand that it is my responsibility to inform The Crypt School of any changes to my personal circumstances; failure to do so may result in funds being reclaimed. Fraudulent claims will be reported to the police.
Signed: / Date:
Parent / Guardian Signature: / Date:
Procedure & Notes
  1. Application form to be completed by the student and submitted by the Friday 21st September.Within 20 working days your application will be assessed by a panel within the school.
  2. The panel will meet to assess applications during Terms 1 and5 of the school year.
  3. Students will then be informed of the panel decision within 5 working days of the meeting: reasons will be given for rejection of an application in whole or in part.
  4. You are entitled to appeal against any decision and this will be dealt with a separate appeals panel within the school.
  5. Payments will be made directly into the student’s bank account.

Procedure & Notes (cont’d)
  1. Following the first panel meeting in October, payments will be backdated to the start of the academic year.
  2. Some provision may be available for immediate emergency payments.
  3. Failure to meet the terms of the Sixth Form Learning Agreement,includingnot working in line with predicted grades,and poor attendance may lead to the cessation of payments. You will be notified of this in writing.
  4. If a student who has received financial assistance leaves before the completion of their course they may be required to repay all or part of their bursary.

Student’s Bank Details
Bank Name: / Bank Sort Code:
Bank Address
& Postcode: / Account No. into which
Bursary will be paid:
For Office Use Only
Actions / Decisions:
Authorising Signature: / Staff Initials: Date: