THE STUDENT SUPPORT FUND APPLICATION /2016

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1 THE STUDENT SUPPORT FUND APPLICATION /2016 IMPORTANT Please read the information below before completing the application DEADLINE FOR APPLYING: Friday 1 st July 2016 (13 th May 2016 for final year students) Subject to funds being available, applications will be accepted throughout the year, up to 5.00pm on Friday 1 st July 2016 We cannot return documents, therefore please provide photocopies. We are unable to process your application if you do not answer all the appropriate sections or provide relevant documentary evidence. Return your completed application form to the Student Centre, Student Centre, Richard Hoggart Building, Room 117 Part 1: YOUR PERSONAL DETAILS 1 Your Student ID 2 Your Title 3 Your Surname/Family Name 4 Your FIRST name/s (in FULL) 5 Your date of birth 6 Your age 7 Your full Correspondence address 8 Telephone number 9 Mobile telephone number 10 Goldsmiths address 11 Are you an international student? Yes No Part 2: COURSE DETAILS 12 Course Title 13 Department 2 nd Department (if applicable) 14 Student Status 1 Undergraduate Postgraduate Full-time Part-time

2 15 Start date of course 16 End date of course 17 Year of course Is this a repeat year? Yes No 19 Is this your final year? Yes No 20 Is this a placement year? Yes No Accommodation details (please tick as appropriate) I live alone I live alone with children I live in shared accommodation I live with my partner or spouse I live with my parents or guardian I live in Goldsmiths accommodation Part 3: YOUR DEPENDANTS 21 Please list any children which are financially dependent on you: (Continue on a separate sheet if required) Childcare How many, if any, of your child dependants require childcare when you are attending college? How many hours of paid childcare do you require per week whilst you are in college? Is your childcare provider registered with Ofsted? Yes No 22 Please list any adults which are financially dependent on you: (Continue on a separate sheet if required) 2

3 Part 4: DISABILITY/HEALTH CONDITION 23 Do you have a disability? Yes No If you answered yes, you may be entitled to apply for Disabled Student Allowance (DSA). For more information see the following website To make an appointment with the Disability Team, please send an to Please give details of disability/health condition (continue on a separate sheet if required) Part 5: STUDENT S INCOME From Student Finance - Student Maintenance Loan From Student Finance - Maintenance Grant From Student Finance - Special Support Grant From Student Finance - Childcare Grant From Student Finance - Parents Learning Allowance From Student Finance - Adult Dependant s Grant From Student Finance - Disabled Student Allowance (DSA) Any Other Grants (please state below) Goldsmiths Bursary or Scholarships - (undergraduates and postgraduates if applicable) Scholarships and Grants (NHSBSA/TDA) Professional Career Development Loan Net Earnings Sponsorships Child Benefit Child Tax Credit Working Tax Credit Housing/Council Tax Benefit Income Support Jobseekers Allowance 3

4 Net earning Parental/Partner contribution Disability Benefits (name benefit/s below) Other income including all saving accounts (please specify) Partner s Income Net earnings Other income Part 5: VARIABLE LIVING COSTS Rent/Mortgage: Monthly/Weekly (please circle) Childcare Costs: Monthly/Weekly (please circle) Travel costs from home to institution Monthly/Weekly (please circle) Travel costs from home to placement Monthly/Weekly(please circle) Private travel costs: Monthly/Weekly (please circle) Road tax Petrol Insurance Course costs (books and equipment) Disability cost not covered by DSA Insurances (not car insurance) PRIORITY DEBT (please provide evidence of all debt) Rent arrears Mortgage arrears Gas arrears Electricity arrears Council Tax NON PRIORITY DEBT (please provide evidence of all debt) Credit Card Loans Catalogue Council Tax arrears Other 4

5 Part 6: SUPPORTING STATEMENT Please state why you are in financial difficulty, and why you believe your situation is exceptional and merits additional support (continue on a separate sheet if required). PAYMENT: Where we are able to make an award from the fund, it will be paid directly into your Bank or Building Society Account via BACS. Complete your bank details below. CONFIDENTIALITY: Applications are only seen by Student Services staff or Governance Services if a complaint is lodged. It may be necessary for additional supporting information to be sought in order for a decision to be reached. DATA PROTECTION ACT 1998: Goldsmiths, University of London follows University policy in matters of data protection. The data requested in this form is covered by the notification provided by the University under the Data Protection Act. Personal data will be used solely in the department for statistical purposes and electronic record keeping. The data will not be passed to any other third party without your consent, except when the University is required to do so by law. Any formal enquiries concerning the use of data noted here should be sent to the Student Centre Part 7: Bank Account Number: BANK DETAILS Sort Code: Please double check your account details as incorrect numbers or illegibility could lead to your award being paid wrongly or delayed unnecessarily. 5

6 Part 8: DECLARATIONS I certify to the best of my knowledge that I fulfil the following criteria: SECTION A must be completed i) I am a UK and national/british citizens: or ii)i am settled* within the United Kingdom (UK) (i.e. have the Right to Abode in the UK or have been awarded Indefinite Leave to Remain (please provide the reference number from your UKBA award notice and submit a photocopy of that award notice, or iii) I have been recognised by the UK Government as a Refugee (please provide the reference number from your UKBA award notice giving the expiry date of your status and a photocopy of the award notice), or iv) I am an EEA or Swiss Migrant Worker or a family member of an EEA or Swiss Migrant Worker. (please tick if you intend to continue working or studying), or vi) I am an EU national who has been ordinarily resident in the UK for the three years prior to the first day of the academic year of your course, or vii) I am the child of a Swiss national, or Viii) I am the child of a Turkish worker. * settled - on the first day of the academic year of your course SECTION B must be completed where applicable I was ordinarily resident** in England, Scotland, Wales or Northern Ireland of the first day of the first academic year of the course, and I fall under either (i), (ii), (iv) or (vi) above and I have been ordinarily resident in the UK and islands for the 3 years immediately before the first day of the first academic year of my course***, or I fall under (iii) above, or I fall under (v) or (vii) above and I have been ordinarily resident in the EEA and Switzerland for the 3 years immediately before the first day of the first academic year of my course, or 6 I fall under (viii) above and I have been ordinarily resident in the EEA, Switzerland and Turkey for the 3 years immediately before the first day of the first academic year of my course. *** Ordinarily resident is interpreted to mean habitual and normal residence from choice and for settled purposes throughout the prescribed period, apart from temporary or occasional absences. Such residence must also be lawful that is, not in breaches of any leave to remain in the UK. (Persons awarded refugee status or humanitarian protection must have been

7 ordinarily resident in the UK 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. SECTION C must be completed where applicable Have you requested and been given a Short Term Emergency Loan (for the academic year ) I confirm that I have registered and in attendance on the course described in the form. PLUS (as appropriate) I confirm that I am supporting the children named in PART 3 (where applicable) I confirm that I am not living with a spouse/partner (if relevant) I confirm that I am registered and in attendance on the course described in PART 2 of this form I declare that the information that I have given on this form is correct and complete I understand that 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 grants obtained by me as a result. Print Name Signed Date FOR OFFICE USE ONLY FOR OFFICE USE ONLY Staff member application received by: Date Application Received By Student Centre: 7

8 8 FULL TIME UNDERGRADUATE AND POSTGRADUATE SUPPORTING DOCUMENTS CHECK LIST Please photocopy all documents submitted with your applications, and indicate the documents provided. Completed BACS form (all Student Finance Breakdown and Payment Timetable (all undergraduate and PGCE students) Evidence of Goldsmiths Bursaries and Scholarships, if applicable (all NHS Bursary letter or Social Work Bursary letter, if applicable (all Student Finance England breakdown letter for Dependants Grant (if you have children or an adult dependant) Teacher Training Bursary, if applicable (PGCE Students) Evidence of income (all postgraduate students) 3 months most recent pay slips or P60 Professional and Career Development Loan/Professional Studies Loan Sponsorships (this includes ALL bursaries and scholarships) Any other forms of income that supports your living costs Child Tax Credit award letter, if applicable (stating the amount received weekly or monthly) Working Tax Credit award letter, if applicable (stating the amount received weekly or monthly) Child Benefit letter, if applicable (stating the amount received weekly or monthly) Childcare Provider letter, if applicable (must include child s name, cost per week or month and must be on letter headed paper with OFSTED /Registration number) Itemised, up to date Bank Statements for all applicants (and your partner where applicable). These must cover: All accounts that you hold The previous 3 months activity within 7 days of your application date All transactions over 100 must have an explanation noted NB Online banking statements are acceptable provided they show your name Evidence of current rent/mortgage eg copy of rent/mortgage statement(all Evidence of benefits received: (if applicable) Housing Benefit Council Tax Benefit Income Support Job Seekers Allowance

9 Disability Benefits Evidence of partner s income: (all 3 most recent pay slips Job Seekers Allowance Any other sources of income Evidence of priority debts: (if applicable) Rent/mortgage arrears Council Tax Gas/Electricity Fines, maintenance and compensation orders Secured loans (e.g. loans that are secured against a debtor s home) Tax and VAT 9

10 PART TIME UNDERGRADUATE AND POSTGRADUATE SUPPORT DOCUMENTS CHECK LIST Please photocopy all documents submitted with your applications, and indicate the documents provided. Completed BACS form (all Student Finance Breakdown and Payment Timetable (all part time undergraduates) Evidence of Goldsmiths Bursaries and scholarships, if applicable (all Evidence of income (all postgraduate students) 3 months most recent pay slips or P60 Professional and Career Development Loan/Professional Studies Loan, Sponsorships Any other forms of income that supports your living cost Evidence of Goldsmiths Bursaries and Scholarships, if applicable (all Child Tax Credit award letter, if applicable (stating the amount received weekly or monthly) Working Tax Credit award letter, if applicable (stating the amount received weekly or monthly) Child Benefit letter, if applicable (stating the amount received weekly or monthly) Childcare Provider letter (must include child s name, cost per week or month and must be on letter headed paper with OFSTED /Registration number) Itemised, up to date Bank Statements for all applicants (and your partner where applicable). These must cover: All accounts that you hold The previous 3 months activity generated within 7 days of your application date All transactions over 100 must have an explanation noted NB Online banking statements are acceptable provided they show your name Evidence of current rent/mortgage eg copy of rent/mortgage statement (all Evidence of partner s income (all 3 most recent pay slips Job Seekers Allowance Any other sources of income Evidence of benefits received: (if applicable) Housing Benefit Council Tax Benefit 10

11 Income Support Job Seekers Allowance Disability Benefits Evidence of priority debts: (if applicable) Rent/mortgage arrears Council Tax Gas/Electricity Fines, maintenance and compensation orders Secured loans (e.g. loans that are secured against a debtor s home) Tax and VAT 11

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