UNPAID PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM

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1 STUDENT ALLOWANCE / STUDENT LOAN UNPAID PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM You can no longer apply for masters or doctorate extensions for Student Allowance payments for study starting on or after 1 January 2013, unless you meet the transitional provisions (set out below). COMPLETE this form if you NEED AN EXTENSION BEYOND YOUR current study end date FOR: YOUR STUDENT LOAN PAYMENTS IF YOU ARE DOING FULL-TIME RESEARCH OR FIELDWORK THAT IS NEEDED FOR YOUR MASTERS OR DOCTORATE; OR YOUR STUDENT LOAN OR STUDENT ALLOWANCE PAYMENTS IF YOU ARE DOING UNPAID PRACTICAL WORK THAT IS PART OF YOUR COURSE. To qualify for an extension of your student LOAN or student ALLOWANCE you must have enough efts 1 to be considered to be studying full-time throughout your enrolment and your extension. If your extension is approved, your Student Loan or Student Allowance will stop after 52 weeks. So if you re still studying full-time after this 52-week period and want your Student Loan or Student Allowance to continue, you need to reapply. The Head of Department or Practical Work Co-ordinator at your education provider also needs to complete a statement in this application. Transitional provisions for masters/doctorate extension for Student Allowance For study starting on or after 1 January 2013, Student Allowance eligibility for all NZQF (New Zealand Qualifications Framework) level 8 and above postgraduate certificates, diplomas, masters degrees, and doctorates has been removed. Note: all Bachelor degrees with Honours will retain eligibility If you are studying NZQF level 8 and above postgraduate certificates, diplomas, masters degrees and doctorates, and are in a recognised relationship and/or have supported child(ren), and: had an allowance approved for study at NZQF level 8 or above in 2012; and are continuing to study the same qualification in 2013; and are retaining eligibility in all other respects, you will continue to be eligible for an extension to your Student Allowance payments until 31 December Note: If you are a transitional (grand-parented) student, you will lose your entitlement to this transitional provision if you: cease to be in that recognised relationship; or cease to have that supported child(ren); or have used the maximum number of weeks you are entitled to (unless you are eligible for an extension). You have a 200 week entitlement limit for your Student Allowance. From 1 January 2014, this will be reduced to a 120 week entitlement limit if you are aged 40 or over at the date you start study. Note: you may still qualify if you meet certain criteria in the transition period. To understand how these changes affect you, please visit our website for more information. We need to receive this application form before the end of your course or it may be declined. 1 EFTS stands for Equivalent Full-time Student. The EFTS value of your course is a measure of the amount of study or the workload involved and is used to decide if the course is full-time or part-time. If you re unsure whether your EFTS value will cover your extended study period, ask your education provider. Find the best way to finance your future

2 Before you start Read this page Here are some important things you need to know before you COMPLETE this form. Use blue or black ink only When completing your application you must only use blue or black ink. If your application has been completed in any other colour we might get you to complete another one. answer all questions You need to answer every question in this application. If a question doesn t apply to you, use N/A or nil. Don t leave the space blank as this could delay the process and you may not get paid on time. Sign and date the form Remember to sign and date this application on page 4. The Head of Department at your education provider must also complete part of this form and sign it. Where to send this form Send your completed form to: StudyLink FreePost PO Box Lower Hutt 5040 If you need more information, visit our website OFFICE USE ONLY Processed by Authenticated by Checked by Signature Signature Signature Date Date Date Comments Certified by Signature Date PAGE 2 UNPAID PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM

3 1. What do you want an extension for? Student Allowance Student Loan Both 2. What is your legal name? This is your legal name as it appears on your Passport or Birth Certificate. First name Middle name(s) Surname or family name 3. What is your date of birth? Day Month Year 4. What is your client number? This is a number issued to you by StudyLink or Work and Income. This is on your Community Services Card if you have one. If you don t have a client number or don t know it, leave this question blank. 5. Where are you living during your unpaid practical work or masters/doctorate study? Flat/House no. Street address Suburb City Country New Zealand 6. Will you be living with your parents or partner during your unpaid practical work or masters/doctorate study? Yes No 7. How can we contact you? Phone Mobile 1 Fax Please give us full details of your course/s? Education provider (full name) Study programme (full name) Start date Student ID 00/0 0/00 9. How long do you need the extension for? From: To: Day Month Year Day Month Year 10. Are you applying for the extension to complete unpaid practical work that is a requirement of your course? Yes (Please give us your work details below) No Employer Start date End date / / / / / / / / 11. are you coming to the end of your entitlement limit for the Student Allowance? If you re unsure call us on Yes No I m not getting a Student Allowance If yes, you may qualify for an extension to your limit if special circumstances exist you can download this form from our website 1 If you give us your mobile number or address we may use this to send you text messages or s. These messages will not contain personal information. We may use them to let you know about important changes, appointment reminders or that it s time to reapply if you re continuing with your studies. This must be your own mobile number or address. Do not give the contact details of your education provider. unpaid PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM PAGE 3

4 PRIVACY STATEMENT The legislation administered by the Ministry of Social Development allows us to check the information that you give us in this form. This may happen when you apply for financial assistance and at any time after that. The Privacy Act 1993 requires us to tell you that: The information you give us is collected under the authority of the legislation administered by the Ministry of Social Development. The information will be held by the Ministry of Social Development. The information is collected for the purposes of the legislation administered by the Ministry of Social Development (including StudyLink, Work and Income, Child Youth and Family and other service lines of the Ministry), and in particular for: granting financial assistance and other assistance under the Social Security Act 1964 and Education Act 1989 (and any Regulations under those Acts) statistical and research purposes providing advice to Government care and protection needs of children providing support and services to you and your family providing education related services providing employment related services. The information may be checked and/or shared with Inland Revenue. The information you give us may be compared with information held by the Ministry of Justice, the Department of Corrections, the New Zealand Customs Service, the Department of Internal Affairs, the Accident Compensation Corporation, Housing New Zealand, Statistics New Zealand, the Ministry of Health, Immigration New Zealand, the Ministry of Education, the New Zealand Qualifications Authority, the Tertiary Education Commission, Student Job Search and education providers. It may also be compared with social security information (for example, pension or benefit information) held by other governments (including Australia and the Netherlands). Under the Tax Administration Act 1994, if you have dependent children, the information you give us may be shared with Inland Revenue for the purpose of administering Working for Families Tax Credits. Inland Revenue may also: use the information for the purposes of child support, Student Loans and taxation disclose it to the Ministry of Business, Innovation and Employment, Statistics New Zealand, the Ministry of Justice, the Accident Compensation Corporation, the Ministry of Education and New Zealand Customs Service disclose your personal information to your partner. Under the Privacy Act 1993 you have the right to ask to see all information we hold about you, and to ask us to correct that information. You are not required to give us information; but if you do not give us all the information we ask for, your application for financial assistance may be declined. sign here STUDENT S Declaration The information I have provided is true and I have not left anything out. I understand that if I make a false statement or don t tell StudyLink of a change in my circumstances that my Student Allowance or Student Loan payments may stop. If this happens I understand that I will have to pay back any overpayments plus collection costs, and I could be prosecuted. Student s signature SIGN HERE Day Month Year PAGE 4 UNPAID PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM

5 This section must be completed by your education provider s Unpaid Practical Work Coordinator or, if applying for a Masters or Doctorate extension, your Head of Department. Authorised staff member s details: First name Surname or family name Position Daytime phone number Education provider/organisation Stamp Education provider/organisation Student s name: First name Surname or family name Extension required: From: To: Day Month Year Day Month Year Name of the course: sign here EDUCATION PROVIDER S Declaration I confirm that the student will need: an extension of their Student Loan, or Student Allowance for study starting on or after 1 January 2013, to complete their full-time research or fieldwork needed for their masters or doctorate or an extension of their Student Loan or Student Allowance to complete their unpaid practical work requirements as part of their course. I also confirm that: the student will be engaged in full-time study for the period stated, and the work to be carried out is essential to the course of study, and during this time the student will have no study breaks longer than three weeks. Signature SIGN HERE Day Month Year unpaid PRACTICAL WORK / MASTERS / DOCTORATE EXTENSION APPLICATION FORM PAGE 5

6 MyStudyLink get it all done online apply for your student finances check to see if your documents have been received check your Student Allowance and Student Loan application status view and update your personal details view details of your next payment and previous transactions view and accept your Student Loan Contract. HOW TO CONTACT US Website: Phone: Fax: StudyLink FreePost PO Box Lower Hutt 5040 Printed in New Zealand on paper sourced from well-managed sustainable forests using mineral oil free, soy-based vegetable inks SL MAST (JULY 2013)

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