Social work bursary: Application form and instructions for students on full-time undergraduate courses

Transcription

1 Business Services Authority Application pack Academic year Social work bursary: Application form and instructions for students on full-time undergraduate courses If you require the bursary application pack in a different format such as large print or Braille etc, contact the Social Work Bursary department. Contents Where to find out more about funding 2 Eligibility 4 How the bursary works 6 What you can expect from us 8 Financial assistance 9 Change of circumstances 10 Your questions answered 11 Contacts 13 How to complete the application form 14 Introduction The social work bursary is administered by the NHS Business Services Authority (NHSBSA) on behalf of the Department of Health, who fund and set policy for the bursary. Although the bursary is administered by the NHSBSA, it is not an NHS bursary. The bursary is administered under the Care Standards Act, which is the legislation authorising the NHSBSA to distribute public funds within the context of the bursary. The bursary scheme also adopts certain elements of the Education (Student Support) Regulations However, the scheme is not legally bound by these regulations. An application must be submitted each year. The application form follows these instructions. The deadline for bursary applications is 28 February The Department of Health introduced the bursary as an incentive to train in social work. The bursary package is non-income assessed.* Unlike funding from Student Finance Direct, which is intended to assist with the cost of living, the bursary grant can be used towards study-related expenses and/or for any legal purpose you deem appropriate. *This means we will not take into consideration such things as your (or any other person s) earnings, savings, dependants, mortgage or rent income, disabilities, special needs or any other similar factors Application instructions page 1 of 14

2 Where to find out more about funding Various care councils in the United Kingdom (UK) offer support to students studying social work. Social care is a policy area devolved to each country. As a result, the NHSBSA does not have policy responsibility for the funding of students from Scotland, Wales or Northern Ireland. You can find contact details for the social care organisations for Scotland, Wales and Northern Ireland on page 13. My residence* My higher education institution (HEI) is in The full-time course I am studying is Whom do I contact about possible funding? England England, Scotland, Wales or Northern Ireland Undergraduate NHS Business Services Authority (NHSBSA) Scotland England, Scotland, Wales or Northern Ireland Bursaries are not available to undergraduates Not applicable Wales England, Scotland, Wales or Northern Ireland Undergraduate Care Council for Wales Northern Ireland Northern Ireland Undergraduate Social Services Inspectorate (SSI) N.B. The five local Education and Library Boards (ELBs) administer the normal statutory education support provision. Please contact your local ELB for funding advice (Table continued on next page) *The country in which you were living before you started any full-time higher education. If you have not yet started a full-time higher education course, it is the country in which you are normally living Application instructions page 2 of 14

3 My residence* My higher education institution (HEI) is in The full-time course I am studying is Whom do I contact about possible funding? Northern Ireland England, Scotland or Wales The Northern Ireland scheme is not available to any Northern Ireland domiciled student studying on any social work course outside Northern Ireland N.B. The five local Education and Library Boards (ELBs) administer the normal statutory education support provision. Please contact your local ELB for funding advice European Union England Undergraduate Department for Innovation, Universities and Skills (DIUS) European Union Northern Ireland Undergraduate EU students will only be entitled to the normal support for EU students under arrangements managed by the Department for Employment and Learning Department for Employment and Learning All information contained in this funding table was correct at the time of publishing but may change. Please check our website at for the most current version of this table. *The country in which you were living before you started any full-time higher education. If you have not yet started a full-time higher education course, it is the country in which you are normally living Application instructions page 3 of 14

4 Eligibility Employment-based courses You are not eligible for a bursary if you are studying on an employment-based course, including direct Open University courses, regardless of whether your social care employer is supporting you. This applies to all students applying for a bursary for the first time from the academic year. GSCC-approved employment-based degree courses are listed on the GSCC website at If you are still unsure if you are or will be enrolled on an employment-based course, please confirm directly with your HEI. If you are eligible to apply for a social work bursary or for help with your tuition fees from the NHSBSA, please complete the application form that follows these instructions to have your eligibility assessed. Joint discipline courses If you are studying on a joint discipline course that includes social work, you must apply to the NHS Student Grants Unit for a bursary. Visit their website at: You must meet both the residency criteria and the other eligibility criteria to be eligible for a bursary. Residency criteria As a student on a full-time undergraduate course, you are required to apply for funding from your English local authority (LA). If they award you with a financial notification, you have met the residency criteria for a bursary. The residency eligibility criteria are defined in the Education (Student Support) Regulations *With the exception of a contribution from your practice learning provider towards your travel expenses that are incurred as a direct result of undertaking your placement duties for them. Application instructions page 4 of 14 Other eligibility criteria You must meet all criteria. You do not already hold a higher education social work qualification, including the Diploma in Social Work (DipSW), awarded by the GSCC, the SSSC, the Care Council for Wales, the NISCC or the Central Council for Education and Training in Social Work (CCETSW, the predecessor to the GSCC). You are entering or already studying on a social work course that has been approved by the General Social Care Council (GSCC), the Scottish Social Services Council (SSSC), the Care Council for Wales or the Northern Ireland Social Care Council (NISCC). You can find a list of GSCC-approved degree courses on the GSCC website at You are studying on a college-based course and you are not receiving funding from a publicly funded body. Note: Funding through Student Finance Direct, the Department for Innovation, Universities and Skills Access to Learning Fund, government benefit agencies and bursaries from your higher education institution (HEI) is excluded. You are studying on a college-based course and you are not receiving any of the following support from an employer: any paid time off to allow you to attend your studies; payment of all or part of your tuition fees; payment from a practice learning provider for undertaking placement duties for them;* funding through the Department of Health s National Training Strategy Grant; or any other form of support to assist with your social work training.

5 You are studying on a college-based course and if receiving a retainer, the retainer meets all of the following criteria: the retainer is offered as an incentive to engage in employment with the retainer provider once the recipient qualifies as a social worker, and not as support towards the recipient s social work training; the retainer is a documented contractual agreement between the retainer provider and the recipient. The contractual agreement indicates the recipient s liability for paying back the retainer to the provider if they do not successfully complete their social work training and/or engage in employment with the retainer provider on qualifying as a social worker; the recipient is not and will not be engaged in employment, be contracted to, on a temporary assignment with or seconded to the organisation(s) providing the retainer, throughout the recipient s social work training; and the retainer is not funded from the Department of Health s National Training Strategy Grant. Application instructions page 5 of 14

6 How the bursary works These instructions and the appropriate application form are for students studying on an approved full-time undergraduate social work course. We define you as a full-time student from your course attendance pattern designated by your HEI. If you are studying on a postgraduate or part-time course, please refer to our website at to download the correct application pack. You need to complete and post us an application form if you are: a first-time applicant; currently receiving the bursary; or re-applying after having received the bursary (in full or in part) and then interrupted your studies. Step 1 Familiarising yourself with the full-time social work bursary Make sure you have read the instructions and the application form in full before completing the application. Step 2 Applying to your English LA As an applicant studying on a full-time undergraduate course, you must apply to your English LA even if you choose not to take out the student loan. This is because your English LA will carry out your residency eligibility assessment and confirm your entitlement to support by giving you a financial notification letter. You must send your original English LA financial notification to us, either with your bursary application or once you receive it. Do not wait for your English LA financial notification before posting your bursary application. When you apply for funding from your LA or with Student Finance Direct using their PN1 or PR1 application form, you will be asked to declare any bursary you may be applying for or receiving from the NHS or the Department of Health. This question does not relate to the social work bursary and you should only tick yes to this question if you are receiving a bursary or award from the NHS and/or the Department of Health other than the social work bursary. If you have been assessed as not eligible for English LA funding, send your original assessment letter from your English LA stating this with your application. If you have been assessed as not eligible because you have received English LA support for a previous higher education course, please send your original assessment letter for the previous course with your application. If you do not have a copy, please contact your English LA to request a copy, which you will need to send to us with your application. For an explanation of why we need your financial notification refer to the section Your questions answered on page 11. First year students please note: We are unable to assess your application until we have received your original English LA financial notification. Continuing students who are not subject to variable tuition fees please note: We are unable to pay your tuition fees until we have received your original English LA financial notification. Continuing students who are subject to variable tuition fees please note: You do not need to send any further notification. Make sure you meet the other eligibility criteria described on pages 4-5. Application instructions page 6 of 14

7 Step 3 Completing the application form Fill in the full-time social work bursary application form. Make sure you answer all the questions. Make sure the name you use on the application is the name that you have used to apply to your English LA and your HEI. Different names or formats of names is likely to cause a delay in processing your application and payments. Additional evidence The only additional evidence we require from you is your original English LA financial notification. Do not send us any other documentation, such as your birth certificate or passport, unless requested. Step 4 Checking your application Check your application for completeness and accuracy using the checklist on the back page of the application form. An incomplete application will delay processing. You may wish to keep a copy of your application form for your own records Please also keep the application instructions. Step 5 Posting your application Post your application to us before the application closing date of 28 February Make sure that you pay the correct postage or your application may not reach us. Post your application as soon as you have completed it in full, even if you have not yet received your English LA financial notification. Post the original notification once you receive it. Step 6 Notification of application outcome You are not eligible for the bursary until you have received the bursary notification letter. Until the assessment of your application is complete we cannot advise you of your eligibility. We can only advise you of the criteria you must meet. The outcome of your assessment is confirmed only by letter, which we will post to you. For dates of when you can expect to receive your letter, refer to page 8. Step 7 Payment of your bursary For payment dates see page 8. All payments will be made by Banks Automated Clearing System (BACS). You will need a UK-based bank or building society account in your name. Your account must be able to accept direct credits. If you re not sure it does, check with your bank or building society. Application instructions page 7 of 14

8 What you can expect from us Get your application in early to prevent delays in payment of your bursary. We will send you a letter telling you if you are entitled to a bursary, and the amount you are entitled to. We will normally deal with your application within 20 working days of the date we get your application form. If you have not heard from us after five weeks, please call the Social Work Bursary department. Do not post another application without speaking to us first. If we need more information or evidence, we will normally deal with your application within 5 working days of receiving the information or evidence we need. Re-assessment A re-assessment occurs when you have already received a payment and there is a change in your circumstances that alters your eligibility and/or we require additional evidence that may affect your financial entitlement. If we are required to re-assess your application we will write to you with the outcome. We normally deal with re-assessments within 5 working days of receiving the complete information and/or evidence we need. Payments The bursary is paid in three instalments: The first instalment will be paid when your application has been assessed as eligible and no later than 30 working days from the date we receive confirmation of course enrolment and attendance from your HEI, or 30 working days from the date of your bursary notification letter, whichever is the later. The second instalment will normally be paid by 16 January The third instalment is normally paid in April. Application instructions page 8 of 14

9 Financial assistance Basic grant If you are subject* to variable tuition fees we will offer you the grant rate below, which is paid in three instalments. Students studying full-time at a London-based HEI Up to 4,975 for a 52-week period. Students studying full-time at an HEI outside London Up to 4,575 for a 52-week period. You are responsible for paying your tuition fees. You can choose to use the basic grant towards your tuition fees or apply for the tuition fee loan from the Student Loans Company. Practice learning opportunity (placement) The basic grant includes a fixed contribution of 575 towards your placement travel expenses from your term time address to your placement agency, and vice versa. It is expected that the agency offering your placement will contribute towards the travel costs incurred while carrying out your placement duties. A contribution of this nature will not affect your entitlement to the bursary. If you are not subject to variable tuition fees we will offer you the grant rate below, which is paid in three instalments. Students studying full-time at a London-based HEI Up to 3,475 for a 52-week period. Students studying full-time at an HEI outside London Up to 3,075 for a 52-week period. We will also pay your tuition fees directly to your HEI after 1 December 2008 (1 March 2009 for winter start). If you withdraw before this date, we are not responsible for any tuition fee payment. We will pay the balance of tuition fees not covered by your English LA up to 1,255. You do not need to take out the tuition fee loan from the Student Loans Company. *If your HEI has the authority to charge you variable tuition fees (regardless of whether they choose to and how much they charge) Application instructions page 9 of 14

10 Change of circumstances If your circumstances change at any time after you have submitted your application, you must tell us immediately in writing. This includes but is not limited to: your address and contact details; any change of course, regardless of whether it is at the same HEI; any change of HEI; change of main campus; change of course attendance pattern (full-time or part-time); change of social care employment; withdrawal, suspension, deferral or interruption from your course, regardless of whether you intend to return; being unable to attend your course for any reason where it exceeds 15 calendar days; any change to the account you want your payments made to;* and gaining support from your social care employer or another publicly funded body (excluding Student Finance Direct, Access to Learning Fund, government benefit agencies and bursaries from your HEI). Minimise debt, fees and charges If your circumstances change after you have submitted a bursary application, you must inform us. It is your responsibility, not that of your HEI, to inform us of any changes to your circumstances (although we will verify the details you provide with your HEI). If we do not receive notification in writing from you of your withdrawal, suspension, deferral or interruption from your course (regardless of whether you are planning to return to the course) within 28 calendar days of the withdrawal, suspension, deferral or interruption date (we use the date according to your HEI), in addition to the overpayment itself you will also be required to pay all reasonable fees and charges incurred by the NHSBSA in recovering the overpayment. Fees incurred by the NHSBSA can be up to 35 per cent of the overpayment. By signing the applicant s declaration on the bursary application form, you agree that you will pay any overpayment and, if applicable, all reasonable fees and charges. We cannot take responsibility for delays with an assessment or payment which arise from your failure to notify us of changes. *If you request that payments be made into a different account, do not close the previous account to which payments were made until you receive a bursary payment into the different account. Depending on the timing of your request and bursary payment cycles, it is possible that bursary payments may be paid into your previous account even after you have notified us of the change of account Application instructions page 10 of 14

11 Your questions answered Why do you need the financial notification from my English LA? Your English LA will carry out your residency eligibility assessment and confirm any entitlement to tuition fee support. I am moving to England from another part of the UK to start my course. Am I eligible for a bursary? No, you will not be eligible for a bursary if you have moved to England only to take up your position on a full-time course. Please refer to Where to find out more about funding on pages 2 and 3 for details of your relevant funding organisation. I know I am not eligible for tuition fee support, as I have previously applied to my English LA. Do I still need to apply to them? You should still approach your English LA, as their assessment process may have changed. I need to undertake a study year I have already attempted. Am I eligible for funding? The bursary is intended as a one-time incentive for each study year of the established course structure. The bursary is not available to students who undertake all or part of a study year they have already attempted, regardless of whether the study year is undertaken on the same undergraduate course or another undergraduate course. Am I eligible for the income-assessed bursary? No, as a student studying on a full-time undergraduate course, you are not entitled to any other bursary that we offer. However, you may be entitled to additional funding from your English LA. Only students studying on an approved postgraduate course are eligible to apply for the income-assessed bursary. I am a student with dependants. Will I receive more money? No, the social work bursary is not incomeassessed. This means we will not take into consideration such things as your earnings, savings, dependants, mortgage or rent payments, disability, special needs or any other similar factors. Will the social work bursary have an impact on any other benefits? English LAs will not take the full-time social work bursary into account when assessing full-time students. However, the bursary may affect your entitlement to other benefits and allowances. If you are awarded the full-time social work bursary, it is your responsibility to inform any appropriate organisations from which you are receiving benefits or allowances. For example, if you are awarded a bursary, and you are receiving housing or council tax benefit, you must inform your LA. Application instructions page 11 of 14

12 Do I have to pay back the bursary? You will not have to pay back the bursary unless you receive an overpayment. This can occur if you experience one of the circumstances listed in section D of the Applicant s declaration on page 11 of the form. It is your responsibility to inform us in writing immediately if you experience one of these circumstances. An overpayment of the bursary* is calculated by dividing the bursary awarded by 365 days. This figure is then multiplied by the number of days you were in attendance. This figure is then subtracted from any bursary payments received. The difference is the overpayment due. If you have an overpayment and you are entitled to further payments of the bursary, these will be used to offset the overpayment. You may still be required to pay back money if any further entitlement does not cover the overpayment. The NHSBSA can only accept payment of an overpayment by cheque or BACS. Otherwise recovery of an overpayment is referred to our debt collection agency. Am I entitled to a payment of the bursary if I stop my studies? You will be entitled to a payment for the days you were in attendance on the course. *If you are subject to variable tuition fees and you receive an overpayment, this will be calculated on the full bursary even if you used all or part of it towards your tuition fees Application instructions page 12 of 14

13 Contacts If you have any questions about the bursary that are not answered in these instructions or on our website, contact the Social Work Bursary department: NHS Business Services Authority Social Work Bursary Sandyford House Archbold Terrace Newcastle Upon Tyne NE2 1DB Tel: Fax: Web: Other helpful contacts Social work careers helpline Tel: Web: NHS Student Bursaries Hesketh House, Broadway, Fleetwood, Lancashire FY7 8SS Tel: Fax: Web: General Social Care Council Goldings House, 2 Hay s Lane, London SE1 2HB Tel: Fax: info@gscc.org.uk Web: If you live elsewhere in the UK, contact the social care regulatory council in your country. Scottish Social Services Council Compass House, 11 Riverside Drive, Dundee DD1 4NY Tel: Fax: enquiries@sssc.uk.com Web: Care Council for Wales Student Funding Team South Gate House, Wood Street, Cardiff CF10 1EW Tel: Fax: Minicom: studentfunding@ccwales.org.uk Web: Northern Ireland Social Care Council (social work course enquiries) Seventh Floor, Millennium House, Great Victoria Street, Belfast BT2 7AQ Tel: Fax: info@niscc.n-i.nhs.uk Web: Social Services Inspectorate (Northern Ireland) (funding enquiries) Student Supporting Scheme, Castle Buildings, Stormont, Belfast BT4 3SQ Tel: Web: Department for Education and Skills European Team PO Box 89, Darlington DL1 9AZ Tel: EU_Team@slc.co.uk Web: Department for Employment and Learning Web: Application instructions page 13 of 14

14 How to complete the application form Important note The application form is for the social work bursary only. To apply for registration onto the English Social Care Register, you will need to contact the General Social Care Council. Their contact details can be found at page 13 or by visiting Completing the form read the application instructions before completing the form. Use blue or black ink and write clearly in CAPITAL LETTERS. Do not use pencil. Answer all questions in full, even if you have previously supplied the details. Use the space in section 7 if you need to continue any of your answers. If your application is incomplete or does not include the evidence we request, processing will be delayed and payments may be delayed. If you need help If you need help or have any questions about completing the form, you can phone our enquiry line on Application instructions page 14 of 14

15 Social work bursary: Academic year Application form for students on full-time undergraduate courses 1 Your details 1.1 About you Are you currently receiving or have you ever received a bursary (in full or part) from the NHS Business Services Authority (NHSBSA), General Social Care Council (GSCC) or the Central Council for Education and Training in Social Work (CCETSW)? No Yes Give details Your bursary reference number 2 Your bursary reference number begins with a 2. It is not your GSCC registration number. Surname or family name First name Other names Use your legal name, which you should also use when applying to your higher education institution (HEI) and local authority (LA). Previous names Date of birth DD / MM / YYYY This will help us to locate your file if you have changed your name since you last applied. Residential address All correspondence will be sent to the address you give here. Town/city Postcode Daytime phone number ( ) Mobile phone number This helps us contact you more quickly and may prevent processing delays. Title Mr Mrs Other Ms Miss Application form page 1 of 13

16 1 Your details continued 1.2 Qualifications Do you have any degrees, diplomas or other qualifications at higher education level? No Yes Give details below Name of qualification Subject Date awarded HEI / / Do not include your A-Level qualifications. / / / / / / Application form page 2 of 13

17 2 About your full-time course 2.1 Course details Full name of social work course Is the course employment-based or college-based? College-based Employment-based Is the course full-time or part-time? Full-time Part-time Download and complete the part-time application pack If you are unsure, check with your HEI admissions department. Placements are an essential component of your study and do not necessarily mean you are on an employment-based course. If you are unsure about what type of course you are studying, refer to page 4 of the application instructions. Type of qualification you will gain BA BSc Other Give details 2.2 HEI details where you will be or are studying Name of your HEI Address This is your teaching institution. Town/city Postcode 2.3 Study details Date you intend to start or first started your course MM / YYYY When do you expect to complete your course? MM / YYYY Year of course you are studying in the academic year st year 2nd year 3rd year Other Give details 2.4 Repeat study Will you need to complete any social work modules from a previous year in the academic year ? No Go to to section 3 Don t know Inform us in writing of details when you know go to section 3 Yes Go to section 3 - we may need to contact you about this Application form page 3 of 13

18 3 Payment method All payments are made by Banks Automated Clearing System (BACS). You must provide your account details by completing the BACS form below. We will not make payments to an account that is not in your name. The account must be in the UK, able to accept payments by direct credit and in the name of the bursary applicant. If you are unsure of these details, please check with your bank or building society. Payments by BACS mean you receive your money faster, provided that you supply the correct information. Please take time to complete this section carefully and write neatly, otherwise it may delay or prevent payments. Name account held in Account details Bank/building society name Branch address Town/city If you are unsure about any of these details, check with your bank or building society. If you miss out any details, your payments may be delayed. Postcode Bank/building society sort code Account number Roll or reference number Building society accounts only This is not your credit or debit card number and may include symbols and letters. Application form page 4 of 13

19 4 Applying to your English Local Authority As an applicant studying on a full-time undergraduate course, you must apply to your English LA, even if you choose not to take out the student loan. Your English LA will carry out your residency eligibility assessment. 4.1 About your application to your English LA What is the status of your application to your English LA? Tick one of the four options below I have applied and have received an English LA financial notification Send your original English LA financial notification with your bursary application. Go to question 4.2 OR I have applied and I am not eligible for support. If you have been assessed as not eligible for English LA funding, send your original assessment letter from the English LA stating this with your application. If you have been assessed as not eligible because you have received English LA support for a previous higher education course, send your original notification for the previous course. If you do not have a copy, contact your English LA to request a copy, which you will need to send to us with your application. Go to question 4.2 OR I have applied and I am waiting for the English LA s decision Give details below. However, do not wait for your English LA assessment decision before posting your bursary application. Send us your English LA assessment letter or financial notification when you receive it. Name of English LA you applied to Date you applied OR I have not yet applied to my English LA Go to question 4.2 Do not wait for your English LA s decision. Post your bursary application now and send a copy of your LA financial notification when you receive it. 4.2 Other LA funding Have you applied or are you intending to apply for any other LA funding not covered at 4.1? No DD / MM / YYYY Yes Give details Name of LA providing support If you need more space to give details, use section 7 of this application form. Name of the grant, bursary, retainer or other support Dates of support From DD / MM / YYYY to DD / MM / YYYY If you are applying for or receiving a retainer, you must complete a bursary retainer declaration. Contact the Social Work Bursary department for this. Application form page 5 of 13

20 5 Other grants, bursaries, retainers or support Have you applied for any other grant, bursary, retainer or support not covered in section 4 as well as the social work bursary? No Yes Give details Name of organisation you are applying to If you need more space to give details, use section 7 of this application form. Name of the grant, bursary, retainer or other support Dates of support From Are you currently receiving any other grant, bursary, retainer or support not covered in section 4 as well as the social work bursary? No Yes Give details DD / MM / YYYY Name of organisation providing support to DD / MM / YYYY If you are applying for or receiving a retainer, you must complete a bursary retainer declaration. Contact the Social Work Bursary department for this. If you need more space to give details, use section 7 of this application form. Name of the grant, bursary, retainer or other support Dates of support From DD / MM / YYYY If you apply for or receive ANY other grant, bursary, retainer or support after you submit your application, you must inform us in writing. Career development loans do not affect your application for a bursary, but if we confirm your entitlement to a bursary, you are obliged to let your loan provider know. to DD / MM / YYYY If you are applying for or receiving a retainer, you must complete a bursary retainer declaration. Contact the Social Work Bursary department for this. Application form page 6 of 13

21 6 Employment details 6.1 Will you be employed in the social care sector during your course? No Go to section 8 Yes You must ask your line manager to complete the following declaration If you are receiving a retainer only, please refer to page 5 of the application instructions. 6.2 Social care employer s declaration to be completed by your employer Note to employers By completing this section you are confirming that the bursary applicant is your employee and is not receiving any of the following: sponsorship/support; any paid time off to allow them to attend studies; all or part of their tuition fees; any practice learning opportunity with pay or any other financial support; support through the Department of Health Training Support Grant; or any other form of support in order to assist with their social work training. The person who completes this declaration must be the applicant s line manager. If you have any questions contact us at: NHS Business Services Authority Social Work Bursary Sandyford House Archbold Terrace Newcastle Upon Tyne NE2 1DB T: E: swb@ppa.nhs.uk F: W: ppa.org.uk/swb About the line manager completing this declaration Manager s surname or family name Manager s first name Manager s job title Title Mr Mrs Other Ms Miss About the applicant s social care employer Name of social care employer Address Town/city Postcode Contact phone number ( ) Application form page 7 of 13

22 6 Employment details continued About the employee Employee s surname or family name Employee s first name Employee s job title Give names to confirm that the applicant is the person employed by the organisation you represent. Type of employment Tick the applicant s type of employment and provide the information we ask for. Full-time/part-time Hours worked per week Permanent Contract Temporary Voluntary Declaration I declare that I am the line manager of the applicant named above and that the applicant is not receiving any support from the social care organisation named on page 7. I understand that if I give the NHS Business Services Authority false, misleading or incomplete information, the applicant named above may be refused financial support or any current financial support may be withdrawn resulting in an overpayment for the applicant and I may be prosecuted. I agree to be contacted by the NHS Business Services Authority so they can verify the employment status and any support arrangements of the applicant named above. Full name Signature Date DD / MM / YYYY Application form page 8 of 13

23 7 Additional space Use this space if you need to continue any of your answers Indicate clearly which questions you are continuing. If you need more space, continue on separate sheets of paper. Write your name and NHSBSA bursary reference number (if known) on each sheet and write the number of sheets you have included here. Attach these sheets securely to your application form. Application form page 9 of 13

24 8 Applicant s declaration Read this declaration carefully before signing it. If you choose not to sign it, we will be unable to process your application for the social work bursary. Third party authorisation Due to data protection, we are only able to discuss your bursary and other personal details with you and the organisations listed in section E on page 11. If you would like to authorise another person, such as a parent, to discuss your bursary, please fill in their details below. We will verify their details if the person contacts us. You must sign the applicant s declaration in order for the third party authorisation to take effect and to indicate that you have sought the person s permission for us to contact them. Third party s first name Third party s last name Third party s date of birth Relationship between you and the third party DD / MM / YYYY This will be used as a security question. A B C By signing this declaration I agree to the following conditions: I have read the application instructions in full and I will supply any additional information which might reasonably be required by the NHSBSA to verify the information I have given on this form. I will inform the NHSBSA immediately in writing of any change in circumstances that might affect my entitlement to financial support or the NHSBSA s records relating to me, including but not limited to: withdrawing, suspending, deferring or interrupting the course temporarily or permanently for any reason, regardless of whether I intend to return; changing my study pattern from full-time to part-time, or vice versa; being unable to attend the course for any reason where it exceeds 15 calendar days in total; changing the account I want my payments made to; changing address; or gaining support from a publicly funded body (excluding Student Finance Direct, Access to Learning Fund, government benefit agencies and bursaries from my HEI) or my social care employer. I accept that the NHSBSA will immediately terminate or suspend my funding if: I withdraw, suspend, defer or interrupt the course temporarily or permanently for any reason, regardless of whether I intend to return; I am unable to attend the course for any reason where it exceeds 15 calendar days in total; I take a year or a term out from study; the NHSBSA determines at its absolute discretion that it is reasonable for it to do so; or I gain support from a publicly funded body (excluding Student Finance Direct, Access to Learning Fund, government benefit agencies and bursaries from my HEI) or my social care employer. Application form page 10 of 13

25 8 Applicant s declaration continued D E F G I will pay back to the NHSBSA immediately any excess payment and all fees and charges as described on page 10 of the application instructions and determined by the NHSBSA as being due, in the event of the following circumstances: changing my study pattern from full-time to part-time; withdrawing, suspending, deferring or interrupting the course temporarily or permanently for any reason, regardless of whether I intend to return; being unable to attend the course for any reason where it exceeds 15 calendar days in total; being overpaid because I have failed to inform the NHSBSA of a change in my circumstances; an NHSBSA office error; where the NHSBSA at its absolute discretion determines that I have been given financial support to which I am not entitled; or gaining support from a publicly funded body (excluding Student Finance Direct, Access to Learning Fund, Government benefit agencies and bursaries from my HEI) or my social care employer. To authorise the NHSBSA to share the information on this form, in compliance with the Data Protection Act (see page 12), with other organisations if necessary, including but not limited to: HEIs; LAs; organisations from which I am receiving benefits, bursaries, grants or support; NHSBSA software suppliers; the Home Office; HM Revenue & Customs; and any other persons or organisation the NHSBSA deems necessary. To inform appropriate organisations from which I am receiving benefits, such as my LA and the Department for Work and Pensions, that I have received a bursary. I understand and accept that if I fail to give sufficient notice of any change to my bank or building society account details, or provide incorrect details, the NHSBSA cannot take responsibility for payments made to an incorrect account, delayed payments or non-payment of the bursary. I understand and accept that the terms and conditions (including rates) of the bursary may change at any time without notice, and that the scheme is subject to continued Government funding, which may cease at any time without notice. I declare that the information I have given on this form is true, complete and accurate. I understand that if I give the NHSBSA false, misleading or incomplete information, I may be refused financial support or financial support may be withdrawn and I may be prosecuted. Applicant s full name Applicant s signature Date DD / MM / YYYY Application form page 11 of 13

26 9 Posting your application to the NHSBSA Social Work Bursary department Keep a photocopy of your application for your own records. Attach a pre-paid, self-addressed special delivery envelope if you wish to have your documents returned to you securely. Pay the correct postage and write your name and address on the back of the envelope to avoid your mail going astray. Post your application and evidence to: NHS Business Services Authority Social Work Bursary Sandyford House Archbold Terrace Newcastle Upon Tyne NE2 1DB Data Protection Act 1998 The NHSBSA will use the information that you have provided for the processing of your application and for the prevention and detection of fraud. We may contact you to discuss your application by any methods you have provided. Your personal data will be deleted from our systems and files no later than seven years after the month in which your application is processed. We will not disclose your personal data to any third party other than: higher education institutions; local authorities; organisations from which you receive benefits, bursaries, grants or support; the Home Office; the Student Loans Company; and HM Revenue & Customs. We will not transfer your personal data outside of the European Economic Area. Application form page 12 of 13

27 10 Checklist Use the checklist below to make sure that your application is complete. Have you read the application instructions that come with this application? Yes No Have you kept a copy of your application form and the instructions for future reference? Yes No Have you answered all the applicable questions in each part of this application? Yes No Have you stapled or securely clipped your original English LA financial notification or assessment letter to this application? Yes No If applicable, has your social care employer completed, signed and dated the employer declaration? Yes No Not applicable If applicable, have you contacted us for a retainer declaration? Yes No Not applicable Have you signed and dated the applicant s declaration on page 11? Yes No Application form page 13 of 13