ACADEMIC YEAR 2017/2018 ONLY FINANCIAL HELP WITH YOUR COURSE RELATED COSTS IF YOU ARE STUDYING A FURTHER EDUCATION COURSE 19+

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1 ACADEMIC YEAR 2017/2018 ONLY FREE COLLEGE MEALS EQUIPMENT COSTS UNIFORM COSTS LEARNER SUPPORT FUND APPLICATION FORM FOR STUDENTS AGED 19+ ON 31/08/2017 UCAS APPLICATION FEE TRAVEL SUPPORT DISCLOSURE AND BARRING SERVICE (DBS) CHECK FINANCIAL HELP WITH YOUR COURSE RELATED COSTS IF YOU ARE STUDYING A FURTHER EDUCATION COURSE 19+ (19 OR OVER ON 31/08/2017) RETURN COMPLETED APPLICATION FORM TO EITHER: LINCOLN COLLEGE GAINSBOROUGH COLLEGE NEWARK COLLEGE WELFARE TEAM WELFARE TEAM WELFARE TEAM STUDENT SERVICES ACLAND STREET FRIARY ROAD MONKS ROAD GAINSBOROUGH NEWARK LINCOLN LINCOLNSHIRE NOTTINGHAMSHIRE LN2 5HQ DN21 2LG NG24 1PB IF YOU NEED HELP UNDERSTANDING OR COMPLETING YOUR LEARNER SUPPORT FUND APPLICATION FORM PLEASE CONTACT STUDENT SERVICES ON (LINCOLN CENTRE, GAINSBOROUGH COLLEGE AND OUTREACH STUDENTS) OR (NEWARK COLLEGE STUDENTS) AND ASK TO SPEAK TO A MEMBER OF THE WELFARE TEAM. VERSION 1 (JUNE 2017)

2 WHO CAN GET HELP? You must be: Ordinarily a resident in the EU for all of the last 3 years (other rules may apply). aged 19 plus on 31/08/2017, on an Education & Skills Funding Agency course, and have started at the College on a course of Further Education (FE). It is not available to learners on Higher Education courses, waged Apprenticeships, Community Learning or provision with learning aims that are identified as wholly funded from other sources. It is also not available to learners in prison, or a Young Offender Institution or who have been released on temporary licence, such as day release. If you are studying a level 3 or above FE course you will not be able to receive support unless i) you are eligible for the 19+ Advanced Learner Loan (ALL) and have used your loan to pay all or part of your course fee or ii) you are aged and studying towards your first Full Level 3 qualification. Should it be found at a later date that you do have a Full Level 3 qualification or above you will be required to repay any support you have received unless you make a successful application for an ALL. Able to show you meet our financial and other eligibility criteria (see Sections 3, 5 and 6 of Application form for full details). PRIORITY IS GIVEN TO SUPPORTING THE FOLLOWING STUDENTS: Priority Group 1 you are in receipt of one of the following Benefits:- Job Seekers Allowance, Pension Credit-Guarantee Credit, Income Support, Universal Credit, Employment Support Allowance, Housing Benefit, Council Tax Support and Working Tax Credit/Child Tax Credit (only if Total Household Income shown on Final Inland Revenue Award Notice 2017/2018 is less than 16,190) or you are the unwaged partner of someone receiving one of these benefits. Priority Group 2 - you live with your parents and your gross income is less than 7,500 per year (py). Priority Group 3 - you live independently as a single person and your gross income is less than 15,000 py. Priority Group 4 - you live with a partner but without any dependent children and your gross household income is less than 22,500 py. Priority Group 5 - you live independently or with a partner and have dependent children for whom you claim child benefit and your gross household income is less than 30,000 py. FINANCIAL SUPPORT AVAILABLE: Course related costs, including: Uniform and Equipment considered by your curriculum area essential for your course, up to a maximum of (Students who qualify for full fee remission or a 19+ Advanced Learner Loan can only get help toward these costs if the items requested will be taken outside of the learning environment. Should this not be the case it is the responsibility of the College School you are studying with to provide what you need to successfully complete your course); UCAS application fee; travel to a maximum of 2 HE interviews (proof of interview and journey cost required); Disclosure and Barring Service (DBS) check. If you receive full fee remission or a 19+ Advanced Learner Loan, it will be the responsibility of the College School you are studying with to pay for the DBS check. Travel to College (See section 5 for further details) Free College Meals (see Section 6 for further details) HOW DO I APPLY FOR HELP FROM THE 19+ LEARNER SUPPORT FUND? Complete the attached application form and return it to Student Services/Main Reception Enclose photocopies of all financial evidence requested or a decision will be delayed We will let you know by /letter within 10 working days (15 days during autumn term 2017) whether or not your application has been successful or if we need further evidence. OTHER INFORMATION: For students receiving income-related benefits we are only able to assist with travel, equipment, childcare and exam or registration fees. These payments must be declared to the appropriate authorities, such as the Department of Work and Pensions (DWP) but may be disregarded by the DWP for benefit purposes at their discretion. Any award paid for a specific item (e.g. equipment) may be deemed the property of the College and you may be asked to return or repay it on completion of your course or if you withdraw early from it. Applications received after the 29/06/2018 will not be accepted. Except in certain circumstances awards will only be made if your attendance is above 90%. The minimum award we will make, subject to eligibility is This fund is cash limited. Support cannot be guaranteed.

3 CONFIDENTIAL UNIQUE ID. LEARNER SUPPORT FUND APPLICATION FOR F.E. FUNDED COURSES ACADEMIC YEAR 2017/2018 FOR STUDENTS AGED 19+ ON 31/08/ STUDENT DETAILS: Surname: Forename(s): Date of Birth: Age (On 31/08/2017): Male Female Address: Tel (Home): Mobile: Post Code: Nationality: At your term time address do you live: Alone with spouse/partner with parents/guardians in halls/shared house Have you lived in the EU for the last 3 years? Yes No (If no please see Student Support Officer in Student Services before completing this form). Are you an Asylum Seeker? Yes No Do you have a learning disability or difficulty? Yes No Do you have an Education and Health Care Plan (EHC Plan)? Yes No Do you receive funding through the Department of Work and Pensions Yes No or Job Centre Plus? Are you in prison or a young offenders institution or have you been released Yes No on temporary licence (ROTL), for example on day release? Is your course a Waged Apprenticeship or Waged Training? Yes No Is your course a Higher Education course (E.g. HNC, HND, Degree)? Yes No 2A. COURSE DETAILS: Student ID Number (if known): Course Title: Course Level: 2B. PLACE OF STUDY: Lincoln College, Monks Road Newark College Gainsborough College Lincoln College, CHT Lincoln College, Queens Park Rand Park Farm Brook House Other (please specify) ALL SECTIONS MUST BE COMPLETED OR YOUR APPLICATION WILL NOT BE ASSESSED.

4 3. FINANCIAL ELIGIBILITY 3A. FINANCIAL ELIGIBILITY CRITERIA ELIGIBLE BENEFITS (PRIORITY GROUP 1) If you provide suitable, photocopied evidence for any of the benefits listed below you may qualify for help with course related costs and/or travel Income Support Jobseekers Allowance Pension Credit Guarantee Credit Employment Support Allowance Working Tax Credit/Child Tax Credit: but only where Total Household Income shown on your Final Award Notice for 2017/18 is below 16,190. Universal Credit Housing Benefit Council Tax Support 3B. FINANCIAL ELIGIBILITY CRITERIA INCOME DETAILS (PRIORITY GROUPS 2 TO 5) If you provide suitable, photocopied evidence that your circumstances meet one of our Priority Groups 2 to 5 you may qualify for help with course related costs and/or travel) PLEASE TICK WHICH EVIDENCE BOXES BELOW APPLY AND ATTACH CURRENT EVIDENCE. PHOTOCOPIED EVIDENCE REQUIRED SELF PARTNER Gross Earnings (Please enclose last 3 payslips if paid monthly or last 6 if paid weekly) Child Maintenance Payments (please provide last 3 months bank statements as proof) Pension (State and Occupational) If self-employed, photocopy of 2016/17 Statement of Income/Expenditure from your Accountant Other Benefits not included in section 3A, including Working/Child Tax Credit where Total Houshold Income shown on your Final Award Notice for 2017/18 is beween 16, 190 and 30,000 (please send all pages) No income, not receiving any benefits (please provide copy of last 3 months bank statements as proof) ENCLOSE PHOTOCOPIES OF EVIDENCE FOR ALL BOXES TICKED ON THIS PAGE. IF YOU DON T YOUR APPLICATION CANNOT BE PROCESSED AND WILL BE RETURNED. EVIDENCE MUST BE RECENT AND CLEARLY STATE THE NAME OF THE PERSON RECEIVING THE BENEFIT OR PAYMENT. BENEFIT EVIDENCE MUST STATE NAME OF BENEFIT RECEIVED 4. DETAILS OF COURSE RELATED SUPPORT REQUIRED: (NOT INCLUDING FREE COLLEGE MEALS) Please list below all course related items for which support is requested, and their costs Equipment (please specify): Uniform (please specify): Other e.g, UCAS application etc (please specify): Other (please specify): Have you already made a full or part payment for any of the above? Yes No (Please enclose copies of receipts) If Yes please state amount. This fund is cash limited we cannot guarantee to support the full amount of your application.

5 5A. TRAVEL SUPPORT RULES & REGULATIONS: Support is only available for days that you attend a timetabled Education & Skills Funding Agency funded course. The maximum the College will award per academic year is 1, ( per week); you will be responsible for paying any additional travel costs. You must maintain a minimum attendance level of 90% to continue getting help. Any future award will be reduced if you fail to do this. For example, if your register shows an attendance record of 75% you will receive 75% of your next travel payment. You will only be paid for days when you have a time-tabled class. If you travel by public transport you must attach tickets to your application form, IF YOU DO NOT YOUR APPLICATION CANNOT BE PROCESSED. If public transport fares rise during the course of the Academic Year we will not increase your award. You must live a minimum of 3 miles away from college and use the cheapest and most appropriate mode of transport and can only claim for one return journey from and to your normal place of residence per day. The rate per mile for travel by car/motorcycle is 20p. You will only be paid the mileage rate from your normal place of residence for car/motorcycle travel if you are the driver. We will work out your mileage using the most direct route to College, according to Google Maps*. The Fund will NOT reimburse car parking charges or parking fines. Students receiving income-related benefits payments must declare support received from this Fund to the appropriate authorities, such as the Department of Work and Pensions but note that they may be disregarded for benefit purposes. This Fund is NOT available to students receiving travel or expenses funding through the Department of Work and Pensions, or Job Centre Plus. Transport support will only be provided from the Term in which you applied to the Travel Support Fund. We will NOT backdate transport support. Applications received after the 29/06/18 will not be accepted Travel support will only be given to the nearest Lincoln College site offering your course except in exceptional circumstances 5B. TRAVEL SUPPORT: You must live a minimum of 3 miles away from college (see* in 5A above), use the cheapest and most appropriate mode of transport and can only claim for one return journey from and to your normal place of residence per day Do you travel by Car/Motorcycle? Do you travel by Public Transport? Yes Yes IF YOU TRAVEL BY PUBLIC TRANSPORT ATTACH ONE WEEK S TICKET(S) AS PROOF OF COST OF JOURNEY Day Please Tick Below The Days You Are In College Please Sign For Each Day You Are In College Tutor Signature To Confirm Tutor Name Monday Tuesday Wednesday Thursday Friday

6 6. FREE COLLEGE MEALS: (Please tick) To be eligible for the Free College Meals Scheme you MUST be aged between 19 and 24. You MUST also be subject to an Education Health Care Plan (EHCP) Please tick here if you are subject to an EHCP. You Must also let us have a copy of your EHCP In addition, you or your parents/guardians MUST ALSO receive one of the Benefits shown below (Please tick which of the following apply and provide photocopied evidence). Income Support Pension Credit Guarantee Credit Support under part VI of the Immigration and Asylum Act 1999 Income-based Jobseekers Allowance Income-related Employment Support Allowance Child Tax Credit, but only where Total Household Income shown on your Final Inland Revenue Award Notice for 2017/2018 is less than 16,190 and you are not in receipt of Working Tax Credit (please submit photocopies of all pages of your Award Notice as evidence with this application form) Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit Universal Credit during the initial role out of this benefit If your application is successful your eligibility for a Free College Meal will commence from the date you attend an induction, when you will receive the means to pay for your meal. Support will not be backdated under any circumstance. Support given will be for the purchase of food up to the value of 2.50 per day. It does not include the cost of carbonated drinks, confectionery or crisps. You will get full details of the scheme when you attend an induction which we will arrange for you with a member of the Student Services Welfare Team ENCLOSE PHOTOCOPIES OF EVIDENCE FOR ALL BOXES TICKED ON THIS PAGE. IF YOU DON T YOUR APPLICATION CANNOT BE PROCESSED AND WILL BE RETURNED. EVIDENCE MUST BE RECENT AND CLEARLY STATE THE NAME OF THE PERSON RECEIVING THE BENEFIT OR PAYMENT. BENEFIT EVIDENCE MUST STATE NAME OF BENEFIT RECEIVED 7. BANK DETAILS: Awards paid by BACS can only be paid in to the student s bank account. This is a national Learner Support Fund Rule. Please take care when completing this section as the College will not accept any responsibility for payments made into the wrong bank accounts due to incorrect or unclear details being entered on this form. Sort Code - - Account Number (Should consist of 8 digits) Please note that the college is no longer able to make cheque payments 8. ADDITIONAL INFORMATION TO SUPPORT YOUR APPLICATION: Please make us aware of anything else which is causing you severe financial hardship.

7 9. WHAT HAPPENS IF MY APPLICATION IS UNSUCCESSFUL? If your application is unsuccessful we will you and let you know the reason why. If you believe the decision made not to support your application is wrong you can appeal in writing to the Welfare Team Leader, Student Services, Lincoln College, Monks Road, Lincoln, LN2 5HQ We will provide a written reply to your appeal within 10 working days of receiving your written appeal. 10. WHAT IF I WANT TO MAKE A COMPLAINT? If you are unhappy with any aspect of the administration of your application or the service you have received you can let us know through the College s Complaints Procedure. Contact the College on the telephone number shown over leaf or visit our website for full details. 11. DATA PROTECTION: The College is a Data Controller in terms of the 1998 legislation. The Student Services Department follows College Policy in matters of Data Protection. The data requested in this form is covered by the notification provided by the College under the Data Protection Act. Personal data will be used solely within the College for the purpose of determining whether or not you should receive assistance from the Learner Support Fund or other College services. Some of the information gathered in this form is required by the Education and Skills Funding Agency (ESFA). Information supplied will be anonymised and aggregated before it is sent to the ESFA. In addition, external auditors are obliged to certify that Learner Support Funds have been allocated in accordance with ESFA Guidelines. As part of this process, auditors will wish to view a small sample of Application Forms. The data will not be passed to any other third party without your consent, except where the College is legally required to do so. 12. DECLARATION: - YOU MUST READ THIS CAREFULLY AND SIGN BELOW I confirm that all the information supplied is correct and agree that the College may seek further evidence as necessary to substantiate my statements, and may require me to attend an interview in relation to this application. I understand that if false or incomplete information is submitted, or I do not tell Lincoln College about any part of my income that is relevant the matter may be referred to the Department of Education or the Police. I could face disciplinary action and/or prosecution. The College will seek to recover any payments I am not eligible for. I confirm that I have read and understand the Data Protection Statement set out in Section 11. I confirm that the bank account details given on this form are my own. I also confirm that I have read & understand the eligibility criteria and rules and regulations contained in the information attached to this application form. I understand that, except in exceptional circumstances, I will only receive support if my attendance is above 90% and my behaviour meets the College requirements. I understand I may have to repay or return any support received if I withdraw early from my course. I understand that if I m aged and receive first Full Level 3 fee remission, should it be found at a later date that I do have a Full Level 3 qualification or above I will be required to repay any support I have received unless I make a successful application for an Advanced Learner Loan. I understand that if I am aged 19 and continuing a programme which I began when I was 18, or I am aged 19 to 24 and received fee remission as I am in receipt of an Education Health and Care Plan, any support I receive will be through the Education Funding Agency s Bursary Fund. Student Signature: Date