Kingston College Bursary Fund Application Form Guidance

Transcription

1 Kingston College Bursary Fund Application Form Guidance Bursary Fund Application Form Please note: * means you must provide evidence to confirm this information. Your application will only be considered when you have completed and signed this form and provided evidence to confirm eligibility and show financial need. Personal Information Title: First Name: Surname: College ID No: Home telephone: address: Mobile telephone: Date of Birth*: Age on 31 st August 2015: Address*: Post code: Please circle/state who you live with Your parent/s Your guardian Your partner On your own A friend Other Please tick to confirm your residential status in the UK 1.UK or EU/EEA citizen 2. Settled Status / Indefinite and have lived in UK for Leave to Enter or Remain/ at least 3 years Right to abode in UK 3.Refugee or Humanitarian Protection 4.Asylum Seeker If you have ticked box 2,3 or 4 you must provide a Home Office letter or passport to prove your residency status Course Information Course Title: Tutor: Full-time: Part-time: Hours and days if part-time: Course start date: 1 year course 2 year course Do you have your own bank account? Yes * No * If not, you will need to open a bank account in your own name as Bursary funds must be paid by BACS into your own account. Bank Details for Payments (this Bank account must be in your own name) Your Name as it appears on your bank Account: Sort Code: (6 digits): Account Number: (8 digits) Type of Financial Support Applied for: Please indicate whether you are applying for the Full Bursary Fund or the Standard Bursary Fund Full Bursary Fund To apply for the Full Bursary Fund you must fall into one of the categories below and you must provide evidence of your status. Please indicate which applies to you: You are in care You are a care leaver You are in receipt of Income Support or Universal Credit (in your own right) You are in receipt of both Employment and Support Allowance (ESA) and Disability Living Allowance (DLA) in your own right

2 Standard Bursary Fund To apply for the Bursary Fund you must provide evidence of your household income being less than 25,000 per year. If applying for the Standard Bursary Fund please indicate which tier applies to you: Tier 1 Funding (Household income of up to 16,190) Travel Contribution: Distance/ Postcode based travel contribution Books/ Stationary/UCAS Student Payment Contribution: Contribution of 150 Course Specific Kit Contribution: 100% of kit costs but only up to a maximum of 500 Tier 2 Funding (Household income of 16,191-20,817) Travel Contribution: Distance/ Postcode based travel contribution. Books/ Stationary/UCAS Student Payment Contribution: Contribution of 100 Course Specific Kit Contribution: 75% of kit costs but only up to a maximum of 375 Tier 3 Funding (Household income of 20,818-25,000) Travel Contribution: Distance/ Postcode based travel contribution. Books/ Stationary/UCAS Student Payment Contribution: Contribution of 50 Course Specific Kit Contribution: 50% of kit costs but only up to a maximum of 250 Free College Meals Free College meals will be provided for year olds whose parents are on a means tested benefit and household income is no more than 16,190 per year and to19-25 year olds who have a Learning Difficulty Assessment (LDA) or Education Health and Care Plan (EHCP). Eligibility Criteria: - Income Support - Income based Job Seekers Allowance (JSA) - Income related Employment and Support Allowance (ESA) - Support under part V1 of the Immigration and Asylum Act A Guarantee element of State Pension Credit - Child Tax Credit (provided they are not entitled to Working Tax Credit) and have an annual gross income of no more than 16,190 as assessed by Her Majesties Revenue and Customs - Working Tax Credit run on- paid for 4 weeks after you stop qualifying for Working Tax Credit - During the initial roll out of the benefit, Universal Credit This means that Working Tax Credit is not a qualifying benefit for Free College Meals and a parent/ student in receipt only of Working Tax Credits is not entitled to a free meal.

3 Do you meet the eligibility criteria for Free College Meal? Yes * No * Additional Information Please use this space to provide us with additional information about yourself to support your application. Please specify how you travel to College and how long your journey takes. Evidence To apply for the Full Bursary Fund you must fall into one of the categories below and you must provide evidence of your status. Status Evidence Y/N You are in care Letter from your Social Worker/ Social Care You are a care leaver You are in receipt of Income Support or Universal Credit (in your own right) You are in receipt of both Employment and Support Allowance (ESA) and Disability Living Allowance (DLA) in your own right Letter from your Social Worker/ Social Care Letter confirming benefit no more than three months old Letter confirming benefit no more than three months old To apply for the Standard Bursary Fund you must provide evidence of your household income being less than 25,000 per year. Please indicate ALL benefits/ Income your household receives. Please also provide evidence of this with your application (photocopies only). * Please note that if you are able to provide the specified evidence of Child Tax credit or Working Tax credit you are not required to provide any further evidence. Name of Income / Benefit Y/N Evidence Needed (photocopies) Y/N *Child Tax Credit All pages of most recent Tax Credit Award Notice or recent Bank Statement showing payment *Working Tax Credit All pages of most recent Tax Credit Award Notice plus Parents/ Carers payslips for the last three months Income Support Employment Support Allowance (ESA)

4 Universal Credit Job Seekers Allowance (JSA) Pension Credit Employment Self-Employment Other Income Parents/ Carers Payslips for the last three months Most recent Self-Assessment Tax Calculation (Gov.uk assessment) Please note that Bank Statements may be required as additional evidence. If you are applying for support with travel costs please provide a print out from of your journey to College by bus. This is required to assess your eligibility. If you are applying for support with costs of Kit or Course Related Materials please provide the kit/ Materials list and associated costs. If you are applying for support with costs of Trips please provide the trip details and associated costs. Declaration/Agreement I declare that the information given in this application is full and correct to the best of my knowledge. I confirm that all taxable income sources are declared. I understand that giving false or incomplete information may lead to legal action being taken against me to recover funds paid and that it may jeopardise my continuing payments from this and subsequent applications. I agree to inform the College immediately if any of the details provided on this form change, particularly change to household income or change of bank details. I understand that bursary payments will only be made to students who meet the eligibility criteria, maintain a minimum of 90% attendance and have positive Tutor reports. I understand that the bursary is to support me to attend College and with College related costs and that if I leave College or do not attend College the Bursary payments will not be made and any equipment purchased on my behalf must be returned to the College. I understand that Bursary Childcare payments will not be made for Holiday periods. I understand that I am responsible for informing the Jobcentre Plus or Benefit Agency of any funds I have received through the College Bursary Fund. By signing this application you are agreeing to the terms set out above and you are signing to confirm that you agree to allow the information contained on the form to be shared with staff at Kingston College. Your data protection rights are not affected. Signed:... Application Form Check List For Staff use Staff notes: Date:... Travel Route and Means of Travel: Number of dependents/ siblings in household: Does the student qualify for the Full Bursary? Completed Bank Details Y / N Kit/ Course Materials List and Costs Y/N Evidence of household Income Y/ N Course Trip Details and Costs Y/N Free College Meals Eligibility Y/N TFL Bus Travel route print out Y/N

5 Evidence of Status (if Full Bursary) Y/N The application form CANNOT be submitted until ALL relevant documents have been supplied and the form is fully completed Support Staff: Administration: You are signing to confirm the application and attached documents are received Date full application received: Staff signature: Approved: Y/N Staff initials: Date outcome letter sent to student: Date: