Student Hardship Application Form

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1 Date Stamp (Office use) Student Hardship Application Form Please read the notes and checklist prior to completing this form. Help is available with filling out the application form from Student Support. If you require help please contact or to arrange a meeting. When returning the form please ensure you have all relevant documents. You will be required to meet a member of the Finance Team who will check the form to ensure it is filled in correctly. Incomplete application forms cannot be accepted. For office use only FCF APPLICATION CHECKLIST YES NO 1 Tenancy agreement (not required for halls) 2 Student Loan paperwork (Undergraduates) 3 Proof of funding / CDL for Postgraduates 4 3 months bank statements all accounts 5 Transaction 100 cr/dr detailed on bank statement 6 Proof of any outstanding bills 7 Proof of overdraft limit (minislip / statement) 8 Income & Expenditure complete 9 Supporting Statement 10 Form Completed & Signed Financial Contingency Fund Student Hardship Fund ACCOM DISABILITY TRAVEL general CHILD CARE EMERGENCY OTHER TOTAL Page 1

2 THE PROCESS Completed application forms should be submitted in person with ALL of the supporting evidence (please see checklist overleaf). Postal applications can be accepted for students not currently residing in Aberystwyth. CONTACT DETAILS Completed forms should be returned to: Student Support, Reception, Ground Floor, Student Welcome Centre, Penglais Campus, Aberystwyth SY23 3FB MONDAY to FRIDAY, 10.00am 3.00pm Service times change during vacation periods, please check with us. Telephone: Your form will be assessed (providing you have attached all of the required information) and a decision made within 15 working days. We aim to process applications quicker than this and this is aided by the prompt provision of all relevant documentation. Grants will only be awarded where a student has insufficient funds available to cover remaining necessary expenditure. All awards are discretionary. HOW TO APPEAL If you are not satisfied with the decision, please contact Student Support for more information regarding our appeals procedure. Page 2

3 Part 1 : Your personal details First name: Student Number: Surname: Date of Birth: Term-time address: Home address: Postcode: Postcode: Contact phone number: Aberystwyth Alternative Are you an independent student? YES NO. If YES, please tick as appropriate: You are 25 or over before the start of this academic year; You have been married or entered into a civil partnership before the start of this academic year; You have care of a child / children; You have supported yourself for at least three years before the start of your course; You have no living parents or you are permanently estranged from your parents. Accommodation: alone / sole adult with partner / spouse halls shared house with parent / guardian Page 3

4 Part 2 : Course details Course title: Department: Undergraduate Postgraduate Postgraduate Writing Up Period Course level: Full-time Part-time Distance Learning Number of credits: End date: Year of course (e.g. 1st): Length of course: Years Is this a repeat year? YES NO Is this your final year? YES NO Part 3 : Your dependants Are any adults or children financially dependant on you? YES NO If YES, please give details. If any of these dependants do not live with you permanently, please indicate how often they stay with you. Name Date of Birth Relationship to you Frequency and length of visits Continue on a separate sheet if necessary. Page 4

5 Part 4 : Income (Please supply the evidence requested alongside each box you complete.) A: ALL STUDENTS monthly EVIDENCE NEEDED Maintenance Loan Parental Contribution Student Finance notification letter and last 3 months bank statements, one showing receipt of loan instalment. Annotate on bank statements or provide a letter / from family stating total contribution over the academic year. CHECK LIST Maintenance Grant / other support grants Student Finance (or other) notification letter Aberystwyth University Bursary Notification letter confirming your bursary Teacher Training Grant Notification letter Professional / Career Development Loan Loan agreement and payment schedule. Disability / Incapacity Benefits Benefit decision notice Part-time earnings (Term Time) Annotate payments on bank statements or P45 if work ended. B: STUDENTS WITH PARTNERS AND / OR DEPENDANTS Partner s Net Earnings Annotate payments on bank statements or P45 if work ended. Partner s Benefits, Pensions, etc. Notification letters Partner s Maintenance Relevant proof Parents Learning Allowance Dependants Grant Student Finance breakdown or bursary notification. Child Care Grant Tax Credits Award notification from HMRC. Income Support Notification letters Housing Benefits / Council Tax Benefit decision notice. Other Benefits, e.g. Universal Credit / Income please specify: Notification letters / relevant proof Page 5

6 Part 5 : EXPENDITURE (Please supply the evidence requested alongside each box you complete.) ALL STUDENTS monthly EVIDENCE NEEDED CHECK LIST Food / Household / Toiletries / Laundry Utillity Bills: Gas / Electricity / Water Telephone Documentary evidence not required for these categories as standard figures are used for assessment. Clothes and Shoes Leisure Rent / Mortgage Tenancy or mortgage agreement. Should also be annotated on your 3 months bank statements. Insurance: Building, Life, Contents Notification document. Council Tax Current Council Tax bill. Daily Travel to University Travel to and from home for vacations Other Expenditure Internet Car Costs Health costs, e.g. eye care, dental care, diagnostic tests e.g. invoice for diagnostic tests Tuition Fees (if not paid by grant, loan, or parent) Other course costs, e.g. field trips, materials e.g. Confirmation from your department that the trip is compulsory, the dates, the location and the cost to you. Receipts for items over 50. CHILD CARE Registered Letter from childcare provider confirming the cost. Unregistered Maintenance Payments Relevant proof, e.g. CSA letter or bank statements. TOTAL Page 6

7 Part 6 : DEBTS (Please list your debts below, including those to the university and store/debit cards.) Creditor person / company owed Amount Nature of debt, e.g. rent, credit / store cards Part 7 : DISABILITY / DYSLEXIA / special medical needs Do you have a disability or chronic medical condition? YES NO Have you applied for Disabled Students Allowance? YES NO (If YES, please provide a copy of your disability support letter.) Are you happy for this information to be shared with the University s Accessibility Services team? YES NO Part 8 : postgraduate students Have you made adequate provisions to cover tuition fees and basic living costs prior to starting your course? (We will require evidence to support this.) ü YES Part 9 : bank / building society details Any award will be paid into the first account shown below. You must supply copies of your last three bank statements (and your savings books) and a printout showing your present account balance for each of your accounts. Please describe all transactions over 100 that appear on the statements. Account Bank / BS name Sort code Savings Accounts / ISAs Account No Roll No (building society only) Overdraft limit Balance at start of year Current balance Continue on a separate sheet if necessary. Page 7

8 Part 10 : SUPPORTING STATEMENT Please state why you are in financial difficulty and require additional support. Include any other information not covered elsewhere on the form. Continue on a separate sheet if necessary. Please explain what steps you have taken to address your financial difficulties, e.g. review your overdraft status, part-time work: Postgraduate Students You are expected to have made provisions to cover your tuition fees and basic living costs before applying to this fund. If you have not taken out a Professional Career Development Loan please explain your reasons: Page 8

9 Part 11 : university debts If you owe money to the University (other than tuition fees for full-time students), and you agree that it can be deducted from your Hardship Fund award, please sign here: Part 12 : PRIVATE SECTOR / THIRD PARTY DEBTS If you owe money to a third party and you agree that it can be deducated from your Hardship Fund award please sign below and provide the relevant bank details: Part 13 : declaration I certify that all the information given on this form is correct and complete and I understand that giving false information may constitute fraud and the University may pursue such matters through criminal prosecution. I understand that giving false information or failing to disclose all relevant information may render me liable to disciplinary action by the University and I may be required to repay any grants obtained by me as a result. I give permission for enquiries to be made of the relevant authorities to substantiate the information provided. I undertake to notify you of any changes in my circumstances immediately, and in the event that I withdraw I undertake to repay any award granted. Signature: Date: Confidentiality: In accordance with the Data Protection Act 1998, all information will be treated in the strictest confidence and will not be divulged to anyone unconnected with the administration of the Hardship Fund, nor any other person or organisation external to the University without your permission. Page 9

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