New College Lanarkshire Childcare and Discre onary Fund Applica on Form

Transcription

1 New College Lanarkshire Childcare and Discre onary Fund Applica on Form For office use only ID number This form should be completed by every student who wishes to apply for Childcare Funding (for their Childcare costs to be paid by the College) and/or Discre onary Funding (previously known as the Hardship Fund). Please complete this form in BLOCK CAPITALS and return to the campus at which you will be studying (no stamp required): Freepost, RSCG REAE CTXS, New College Lanarkshire (Motherwell Campus), 1 Enterprise Way, Motherwell, ML1 2TX Freepost, PRAL LSDC BKUR, New College Lanarkshire (Coatbridge Campus) Kildonan Street, Coatbridge, ML5 3LS Freepost RTGT YCZJ RSCZ, New College Lanarkshire (Cumbernauld Campus) Town Centre Cumbernauld G67 1HU Important Informa on If you are applying for Childcare for more than four children, please complete an addi onal applica on form. Only parents and legal guardians may apply. Please do not send original documenta on as they will not be returned by post. The College reserves the right to ask for sight of original documenta on. Please submit the required evidence with your applica on as detailed in Sec on J of this form. Your applica on cannot be processed without these. Incomplete forms will be returned to the applicant. This may result in a delay in processing your applica on. For applica on informa on call and ask for Student Funding of the campus you are studying. Applica on To which fund are you applying ( ck all that apply): Childcare Fund Discre onary Fund (including Housing/Accommoda on Costs) Policies Policies in rela on to the requirements, responsibili es and applica on of these Funds are published on the College Website. It is important that you have read and understood these policies prior to making your applica on. Please ck to confirm that you have read the Childcare Funds Policy. Please ck to confirm that you have read the Discre onary Funds Policy. College Policy requires that if you are applying to Childcare and/or Discre onary Fund, that you have, first of all, applied for all other forms of available Funding. Please confirmed that you have applied for (please ck one): Bursary Ref No: Bursary/EMA SAAS Ref No: SAAS Have you applied for or received Discre onary Funds from any other ins tu on? Yes No Sec on A: Applicant Details Surname: First Name (s): Title (Mr/Mrs/Miss/Ms): Date of Birth: Telephone (including area code): Mobile:

2 Address: Postcode: Sec on B: Course Details Course Title (you will find this on your offer le er): Start date: Level: Full Time Part me Day release Con nuing Student Sec on C: Details of Child/Children (Please only complete this sec on if you are applying for Childcare Funding) Please complete in chronological order (eldest child first). Child One Surname: First Name (s): Male: Date of Birth: Female: Child Two Child Three Child Four Sec on D: Details about Childcare Providers (Please only complete this sec on if you are applying for Childcare Funding) Using the same chronological order as per Sec on C (above), please tell us which Childcare provider is used for each child and the type of facility provided. First Name Name of Childcare Provider Please ck Please ck Please ck College Nursery External Nursery/ Childminder A er school Care Child One Child Two Child Three Child Four Lone Parent Informa on: If you are a Lone Parent, you may be assessed for further Lone Parent/Childcare Grant Funding. Please confirm if you would like to be assessed for the Lone Parent Childcare Grant: Yes No/Not applicable Sec on E: Details of your Bank/Building Society Account (the account to which your payments will be made). Student s Name (as detailed on Bank/Building Society Account) Name and Address of Bank/Building Society Bank Sor ng Code/Building Society Account Bank Account Code/Building Society Account

3 Sec on F: Details of Income, Expenditure and Debts (do not complete if you re applying for Lone Parent/Childcare grant only) *FURTHER EDUCATION STUDENTS ONLY Your income for the 2013/14 Tax Year will have been assessed as part of the Bursary/EMA process. The College do not intend to ask for addi onal income informa on unless your circumstances are likely to change for the 2014/15 year. I confirm that my household income will be approximately the same for 2014/15 as it was 2013/14. My household income will be poorer by in the year 2014/15. Please provide details at Sec on H. My household income will be be er by in the year 2014/15. Please provide details at Sec on H. Please now go to Sec on H and complete the Expenditure Sec on. Sec on G: Details of Income, Expenditure and Debts (do not complete if you re applying for Lone Parent/Childcare grant only) **HIGHER EDUCATION STUDENTS ONLY Your income for the 2013/14 Tax Year will have been assessed as part of the SAAS process. The College do not intend to ask for addi onal income informa on unless your circumstances are likely to change for the 2014/15 year. My SAAS award no ce amounts to My SAAS loan (if applicable) amounts to I confirm that my household income will be approximately the same for 2014/15 as it was 2013/14. My household income will be poorer by in the year 2014/15. Please provide details at Sec on H. My household income will be be er by in the year 2014/15. Please provide details at Sec on H. Please now go to Sec on H. If you have not received your SAAS Awards no ce and loan informa on please complete the Income and Expenditure Sec ons. If you have provided SAAS Awards no ce and loan informa on, please complete Expenditure sec on only. *Further Educa on students studying below HNC Level (SCQF Level 7). *Higher Educa on students studying HNC Level (SCQF Level 7) and above.

4 Sec on H: Details of Income, Expenditure and Debts (do not complete if applying for lone parent/childcare fund grant only) Please note, the Income sec on is only applicable to those HNC and above students who have not yet received their SAAS Awards no ces (including loan no ces). The Expenditure sec on is applicable to all students, therefore all applicants must complete the Expenditure sec on. Income (detail of weekly income from all sources during College year) Expenditure (detail of weekly expenses e.g. Rent, gas, food, etc) Type of Income Amount () Type of Expenditure Amount () Learner s Wages Other Income of Student Learner s/spouse Partner s Income Maintenance payments received Income from children Child Benefit Child Tax Credit Working Tax Credit Private Pensions Student Loan SAAS Grants State Benefits Other Income (Please Specify) Rent/Mortgage Council Tax Groceries Electricity Gas Insurance Telephone/Internet Mobile Phone Course Books, etc Car Costs (Road Tax & Insurance) Petrol Public Transport TV Licence Other costs (Excluding debts) TOTALS TOTALS All Students - Details of Debts (held in your own or joint name) Name of Creditor Amount Outstanding Minimum Monthly Payments Debt End Date All Students - Details of Bank Balances (your own bank details, your partners and any joint accounts) Name of Bank Balance at date of applica on

5 Sec on I: Other informa on Please give any further informa on that you feel would support your applica on, using a separate piece of paper if you require more space. Sec on J: Documenta on Checklist (photocopies please) Students must have applied for all other funding available to them including FE Bursary, EMA, SAAS Grants and Loans. Bursary Award Le er or Bursary Reference Number Student Loan Le er/saas award le er Any other award le ers Recent bank/building society statements (for all banks for two complete months) Evidence of current rent/mortgage charge Child (s) birth cer ficates (if applying for financial assistance from Childcare Funds) Evidence of status (if single parent) Tax credit award no ce External Childcare applica on (a ached) if child(ren) are not in College Nursery Council Tax Bill Evidence of Partners Income Evidence of your Employment/Self Employment Income Evidence of Debts Sec on K: Applicant Confirma on The informa on given on this form is correct to the best of my knowledge. I will abide by all College and Policies and Regula ons including those on a endance and conduct. I will inform the College of any changes to my circumstances or details. Signature: Date: By signing this form, you consent to New College Lanarkshire holding and processing your personal data for all purposes connected with your studies in College and the College's statutory and business requirements. All communica on with the College is treated confiden ally and is protected under the Data Protec on Act Informa on provided will not be disclosed to a third party. For office use only Date of applica on Received Date of placement offer Status on Unit E Start Date End Date Reason

6 For office use only Income SAAS Award Student Loan Bursary Award EMA Award Household Income assessed during Bursary/EMA process Income Adjustment Total