PLEASE ENSURE THAT YOU ANSWER ALL QUESTIONS FULLY AND CORRECTLY. 1. Are you applying for Hardship Childcare/Children Both

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1 Dumfries Campus - Application for an award from the HEI Discretionary and Childcare Funds PLEASE ENSURE THAT YOU ANSWER ALL QUESTIONS FULLY AND CORRECTLY A. PERSONAL AND COURSE OF STUDY DETAILS 1. Are you applying for Hardship Childcare/Children Both 2. Student Number Age at Date of birth. /.. /. 3. Surname... First Name 4. Term Time Address.. Postcode.... Telephone. 5. Type of Accommodation:- University Hall of Residence/Student House Private Rented/Leased Accommodation Living in Parental/Guardian s Home Other (please give details).. University sub-leased flat Homeowner (ie mortgage) Rented from Council/ Housing Association 5a. Do you receive Housing Benefit YES NO 6. Male Female 7. Marital Status: Single / Widowed /Divorced / Separated / Married / Civil Partnership/ Living with partner (Circle as appropriate) If you are under 25 and married please enclose a photocopy of your Marriage Certificate Is your partner/ex-partner currently studying at Glasgow University? *YES/NO *If yes please give his/her full name and registration number Tick as applicable Full time Student Part time student Thesis Pending student *Exams only student *Exams only students are not eligible to apply to this fund 9. a) Degree for which you are registered eg (MA, PhD). b) College (eg Arts, Social Science) 10. a) Year of study (eg 1 st, 2 nd ). b) When do you expect to graduate (eg July 2016).. Page 1 of 6

2 B. FUNDING 1. Have you received assistance from the HEI Discretionary/Childcare Fund YES NO Before? (Please note only one application for assistance per academic year) If YES, please give session(s) and amount(s) 2. Are you in receipt of the Care Leavers Grant? YES NO If YES, please give session(s) and amount(s).. 3. Have you provided SAAS/SFE/SFNI/SFW with details of your YES NO Parents/partners income details? If NO please explain why..... (We require a photocopy of your SAAS Award Notice/Full Financial Notification AND your Student Loan Payment Schedule Letter) C. ELIGIBLITY 1. What is your fees status? (tick relevant box) Home International EU 2. Do you stay in the parental home during term-time? YES NO 3. If you stay in rented/leased accommodation, is your landlord related to you? YES NO If YES, please state relationship If you have answered yes to questions 2 or 3 above you are not eligible to apply for assistance with accommodation costs (you may be eligible for assistance under another category see below). Award from Childcare Fund/HEI Discretionary Funds required for: (please tick relevant boxes) *Children/ Informal Childcare Costs *Registered Childcare Costs *Lone Parent Childcare Grant Accommodation Costs Mature Student Additional Expenditure incurred through a Permanent or temporary disability/illness (Please provide a letter outlining what your additional costs) Books and travel for Part time undergraduate students only (studying 60 credits or more) *Please note if you are applying for children/childcare costs please complete page 5 Details of your Childcare/Children form. This must be submitted with your complete application form. Incomplete application forms will be returned. Page 2 of 6

3 D. ANTICIPATED MONTHLY INCOME FROM ALL SOURCES FOR SESSION 2015/16 Note do not leave blanks if an item of expenditure does not apply enter 0 YOU 1. SLC Ltd Student Loan 2. SAAS Young Persons/Independent Bursary Fund/ Dependants Grant 3. LEA/NIELB Maintenance Grant 4. Parental /Spousal Contribution 5. Expected/Estimated Earnings for full session* 6. SAAS Lone Parent Grant 7. Care Leavers Grant 8. Child Maintenance (from ex-partner) 9. Child Benefit 10. Child Tax Credits 11. Working Tax Credits (Childcare Element) 12. Working Tax Credit 13. Funding from the University ie: welcome bursary, second first degree bursary fund 14. Income from any other source (ie Tenant/Lodger, Loan, Scholarships, benefits, Pensions etc. Please specify and provide documentary evidence 15. Savings (including ISA) TOTAL MONTHLY INCOME *PARTNER (if applicable) Please divide all income by 12 months, unless ug students are in their final year they should divide their loan by 9 months. E. ANTICIPATED MONTHLY EXPENDITURE FOR SESSION 2015/ MONTHLY RENT AND/OR MONTHLY MORTGAGE (including Endowment, PEP or ISA if applicable) Evidence required, an amount on a bank statement is not acceptable 2. Council Tax 3. *Food (including toiletries & non food groceries) 4. Books 5 Utility Bills Gas/Electricity 6. Telephone/Internet/TV packages 7. Travel (including termly or annual return tickets, trips home) 8. Registered/Formal Childcare Costs (ie Nursery, Registered Childminder, After School Care) 9. Informal Childcare Costs (ie: Neighbour, grandparent) 10. Other Costs ie: insurances, socialising, memberships, clubs, clothes, debt repayments Please specify what each amount is for. TOTAL EXPENDITURE PER MONTH Please deduct D from E to show your balance *if your food costs are higher than average ( 140 per month single person) please provide an explanation Page 3 of 6 You & partner OFFICE USE ONLY

4 F. OUTSTANDING DEBTS Monthly Total Repayment Outstanding Amount BANK OVERDRAFT CREDIT CARDS LOANS OTHER THAN SLC STUDENT LOANS OTHER (Please give details) TOTAL G. APPLICANTS STATEMENT Please complete the section below supporting your reason for applying to the fund. This section is mandatory and must be completed by all students. The University reserves the right to check all information and documentation supplied with application forms. The information provided on forms, and all documentary evidence, will be thoroughly checked and investigated by the University for auditing purposes. Any application found to be made on a fraudulent basis will be referred to the Senate Assessors for discipline H.DECLARATION I will inform Financial Aid Staff immediately of any change of circumstances affecting this application and undertake to collect any award made to me within 4 weeks of notification. I confirm that I have provided a truthful account of my situation and have provided evidence of ALL bank accounts held by me. (I understand that if I fail to comply, the University reserves the right to cancel any award made to me). X Signed. Date. X The completed form should be returned to the staff in Level 2, Fraser Building as soon as possible after registration. Page 4 of 6

5 Details of your Children/Childcare costs To be used only with the HEI Discretionary and Childcare Fund Application Form 1. Student number. 2. Surname.. First name Number of dependant children Child 1 Do you pay for: Formal/Registered Childcare Costs Informal Childcare Costs None Name of child. Age.. Date of Birth./../.. *Local Authority Registration Number. *Overall Weekly Childcare Cost (for child one only) *Dates of Childcare Provision... *If applicable Child 2 Do you pay for: Formal/Registered Childcare Costs Informal Childcare Costs None Name of child. Age.. Date of Birth./../.. *Local Authority Registration Number. *Overall Weekly Childcare Cost (for child 2 only) *Dates of Childcare Provision... *If applicable Child 3 Do you pay for: Formal/Registered Childcare Costs Informal Childcare Costs None Name of child. Age.. Date of Birth./../.. *Local Authority Registration Number. *Overall Weekly Childcare Cost.. (for child 3 only) *Dates of Childcare Provision... *If applicable Please also ensure that you have enclosed photocopies of your child/children s birth certificate(s) You must provide documentation of childcare costs. This should take the form of a recent letter from your childcare provider and contain the following information: 1. Local Authority Registration Number (if formal/registered childcare) 2. Name of your child/children 3. Overall Weekly Amount 4. Date of Childcare Provision (ie: Sept 2015 to May 2016) 5. If registered childcare this statement should be on headed paper with name and address of childcare provider as well as authorised signature. 6. You must enclose documentary evidence of your Tax Credit Award Notification for 2015/16 if you are in receipt of this. Failure to provide evidence will result in your application form being returned to you. Page 5 of 6

6 CHECKLIST Please tick where applicable that you have enclosed the relevant documentary evidence for your application to be processed. PHOTOCOPIES ONLY originals will not be returned. All documentation should be relevant to the current academic year. PROOF OF INCOME FOR OFFICE USE ONLY SAAS Award Notice 2015/16 (both sides) SLC Payment Schedule Letter 2015/16 Award Notification Letter from Student Finance England/Wales/N.I. (full document) Most recent salary slip of you/partners earnings/benefit Tax Credit award Notification 2015/16 Housing benefit statement EVIDENCE OF RENT /MORTGAGE COST Rent/Mortgage Costs ( amount on bank statement Not sufficient) lease or annual statement required. Document should include your name, property address Name, Dates of agreement, weekly/monthly costs CHILDCARE/CHILDREN Birth certificate(s) of Dependant Children Evidence of Registered childcare costs (see page 5) Evidence of Informal childcare costs (see page 5) OTHER Two months most recent bank statements for all Accounts held in your name Evidence of books and travel costs for UG part students only, must include a receipt showing at least one book purchased and a copy of your book list showing books required for your programme. (must be studying 60credits or more) Marriage Certificate (see Q7) Letter detailing weekly/monthly costs incurred by a Disability/special needs (if applicable) Failure to provide all required documentary evidence will result in your application form being returned to you. Page 6 of 6

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