*You will be required to provide evidence to prove residency status i.e. passport, Home Office documents etc. Received by.. Date. Receipt No.

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1 Received by.. Date. Receipt No. Advanced Learner Loans Bursary Application Form 2016/17 To apply for this Bursary you must have applied for, and been awarded, an Advanced Learner Loan for your fees. (You will be required to provide evidence of this). Your gross household income must be 24,000 or less Part 1: Personal Details (please print) Student ID Number Name (in full) Date of Birth Address Age at start of course Post Code Telephone Number Address RESIDENCY You must complete this section What is your status in the UK? (i.e. British/EU Citizen, Refugee*, Asylum Seeker*) How long have you lived in the UK/EEU? Years Months If you have lived in the UK/EEU less than 3 years when did you arrive in the UK/EEU* Year Month If you have lived in the UK/EEU less than 3 years where did you live before your arrival in UK/EEU* *You will be required to provide evidence to prove residency status i.e. passport, Home Office documents etc. Please tick any of the following circumstances that apply to you I have Learning Difficulties and/or Disabilities I have recently left Military Service I need help with childcare costs Part 2: Course Details Course Title Level Year of Course Year 1 Year 2 Hours of Study Full Time Part Time No. of hours per week (if part time) 1

2 Part 3: Personal Status/Accommodation details Do you live: Alone With your Partner or Spouse With your parents or guardians In shared accommodation Other (please state) Do you have children under the age of 20 in full Yes No time education living in the household? How many? Are you a single parent? Yes No Do you share household expenses? Yes No If yes, who with? Do you receive help with travel or childcare Yes No costs from Jobcentre Plus or a Work If yes please give details Programme provider? We must take into account the availability of any other financial support when making decisions about awarding public funds Part 4: Income Are you married, in a civil partnership or living with someone as if you are married? YES We need to know about your spouse or partner s income as well as your own. NO We need your income (not your parents if you are still living with them). If you live alone we need a Council Tax letter to prove single occupancy or Tenancy Agreement if you are living in shared accommodation. You must provide original evidence of all household income and benefits, showing the type of benefit and the amount received. Your application will be assessed on the total amount of gross household income including earned income, tax credits and benefits received. (We will disregard income from Child Benefit and Disability Living Allowance/Personal Independence Payments). Please indicate ALL of the income/benefit you receive in the table below, and provide the evidence for each one. A Tax Credit Award Notice for 2016/17 must be supplied for all applications As part of our assessment process we may ask for further evidence to support your application Income Received (please tick) Employment (includes paid employment and self-employment) Means Tested Benefits (includes Universal Credit, Job Seekers Allowance, Income Support, Working/Child Tax Credit, Housing and Council Tax Benefit etc.) Non-Means Tested Benefits (includes Employment & Support Allowance, Disability Living Allowance/Personal Independence Payment, Carers Allowance, Incapacity Benefit etc.) Pension and other benefits not included above Evidence Required P60 for 2015/16 tax year or SA302 (copy of selfemployment accounts certified by Accountant) Original current benefit letter showing the amount of benefit awarded, this letter should be dated within the last 3 months Original current April 2016 benefit letter showing the amount of benefit awarded Pension Statement for 2015/16. Original 2016 benefit letter showing the amount of benefit awarded, this letter must be dated within the last 3 months. 2

3 No income or benefits, living with Bank statements for 3 months prior to your parents who provide support application IMPORTANT: It is your responsibility to inform the Department for Work and Pensions of any award made to you as this may affect your eligibility to some benefits. Part 5: Bursary Categories, Criteria and Eligibility All students must have had an Advanced Learner Loan approved by the Student Loans Company for course fees and provide a copy of their award letter Gross household income (including earned income, tax credits and benefits) must be below 24,000 All awards are subject to students being fully enrolled and having satisfactory attendance in line with College Policy You can apply for one or more of the following:- Category Please tick Criteria Learning Support For In Learning Support Funding based on assessment by the Inclusive Support Team to identify the additional support you need while attending your course. Childcare Government funding for 2, 3 and 4 year olds must be claimed if available Maximum of 2 children funded per student. Contribution payable of 50 per term for each child if using College Nursery or pay 5% of fees if using an outside nursery (payable direct to childcare provider). No other assistance with childcare from spouse/partner or other family members available. Nursery Information and Costs Form to be completed and returned to Student Support Team before start date of course. Bursary Bursary Grant of up to half termly payments of up to 150 to help with costs of coming to College (e.g. travel, materials, books, trips, university interviews etc.). Pro rata awards for part time student (dependent on number of timetabled hours) Bursary awards will be made by BACS transfer into your bank account. You will need to complete the attached Bank Details Form Fair Processing Notice - Data Protection Act 1998 The Information that you provide on your application form will be processed by The College and will be used for a number of purposes. These include administration, planning and management of your education, administering student and College funding. The College is legally obliged to pass information to the funding agencies as part of our obligations under current legislation and funding agreements. We may share your information upon request with the Police where knowledge of or involvement with a crime is suspected. All information provided will be dealt with in accordance to the College s Data Protection Policy and at no time will your personal information be passed to other organisations for marketing or sales purposes. Part 6: Declaration and Signature I have read the Fair Processing Notice Data Protection Act 1998 above. I declare that I am in receipt of an Advanced Learner Loan for my fees. I declare that the information I have given in this application is complete and correct and that all household income sources are shown. I understand that giving false information will disqualify my application and may result in referral to the police and that I may face criminal prosecution. I understand that payment of awards is subject to satisfactory attendance which will be checked using the College s register system. I understand that I must notify the Student Support Team immediately if I change, or withdraw early from my course and that any payments made to which I am not entitled will have to be repaid. Name (please print) 3

4 Signature Date Guidance Notes for Applicants What is the Advanced Learner Loan Bursary Fund? The Advanced Learner Loan Bursary Fund is used to help Walsall College students, in receipt of an Advanced Learning Loan, who may be experiencing financial difficulty to complete their course, in particular those with learning difficulties or disabilities, those with parental responsibilities and exmilitary personnel. While we recognise that students face financial pressures, the funding you are applying for comes from a government fund and is public money. It is not a right. The College has a duty to ensure that the funds are awarded fairly and to students most in need. We must take into account the availability of any other financial support when making decisions about awarding public funds. Am I eligible to apply? You must have an Advanced Learner Loan approved by the Student Loans Company for your tuition fees. You will need to provide your Advanced Learner Loan Award Letter. You must be enrolled to a course at level 3 (or above). Your gross income must be within the following income threshold limits for the Fund. Joint income if living with spouse/partner Single applicant living with parents or OR single applicant living independently guardians 24,000 or less 10,000 or less How do I apply? Complete the application form in full Sign and date the declaration at the end of the form Attach the original evidence of income as required this will be copied and returned to you Hand in your application to the Student Support Team at the Wisemore or Green Lane Campus. You will be given a receipt please retain this for future reference Incomplete forms, or forms submitted without the required evidence will be returned to you What happens next? We aim to process applications within 10 working days. You will receive an award notification letter which will indicate your award and how this will be provided. No payments will be made to you until you are fully enrolled to your course. If your application is not successful you will be notified by letter. You will then need to decide if you are able to enrol on your course without financial support from the Fund. Can I appeal? You have the right to appeal if your application is refused. You must submit your appeal, in writing, within 10 working days of receipt of your refusal letter. You will be required to submit additional information to support your appeal. Further information and advice is available from the Student Support Team in the Customer Advice & Support Centre (CASC). Telephone and ask for the Student Support Team studentsupport@walsallcollege.ac.uk Further information about 24+ Advanced Learning Loans, including details on repayment and interest can be found at 4

5 Independent financial advice is available at WALSALL COLLEGE BURSARY FUNDS BANK DETAILS FORM Please complete this form clearly and accurately to enable us to make payments direct to your bank account via the BACS payment system. You must advise us, in writing if you change your account to ensure that we hold your correct bank account details. Please provide a recent bank statement so that we can check your bank details are correct. We are required to make payments directly to Students Bank Accounts only. Please ask to speak to a member of the Student Support Team if you do not have a bank account. Please note that the College cannot accept responsibility for any payments that are delayed, or lost, due to errors made when completing this form, or if you have failed to notify us of any change to your bank account details. We cannot make BACS payments into Post Office Accounts Learner Name Learner Pass Number Name of Bank Address of Bank (where account is held) Name on Bank Account Bank Sort Code (6 numbers) Bank Account Number (8 numbers) Building Society Roll Number (Entered/Amended By (Staff) Date ) To be completed by students who do not have a bank account: I do not have a bank account. Please pay my awards into my parent s account above Signed: Date: DATA PROTECTION ACT 1998 In accordance with the requirements of the Data Protection Act 1998, Walsall College has a duty to protect the personal data it processes. To comply with this legislation, information must be collected and used fairly, stored safely and not disclosed to any person unlawfully. This is outlined in our Data Protection policy, a copy of which can be obtained from the Data Protection Officer. Use of personal data contained within this form will only be used for its intended purpose and in accordance with the College Data Protection Act 1998 registration. We will not release any personal information to 3 rd party organisations without obtaining your written consent. 5

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