16-19 Bursary Fund Application Form

Transcription

1 16-19 Bursary Fund Application Form

2 Application Form Bursary Fund What is the Bursary Fund? The fund is made available from the government through its funding body Young People s Learning Agency (YPLA) for year olds at the start of the academic year to provide assistance to students whose access to, or completion of, education is inhibited by financial constraints or barriers. The new Bursary Scheme for year olds has been put in place as a partial replacement for Education Maintenance Allowance (EMA). Who is eligible to apply for Bursary Funding? Students following government (YPLA or SFA) funded full time or part-time courses, who are 16 years and over and satisfy one or more of the following criteria:- Students aged at least 16 and under 19 years of age on 31/08/13 who are in care, are leaving care, are in direct receipt of Income Support or are disabled and in receipt of both Employment Support Allowance and Disability Living Allowance Students who are economically or socially disadvantaged and at risk of not taking up or continuing in their education/training due to financial constraints. Who is not eligible for Bursary Funding? Students under 16 years of age or over 19 years of age on 31/08/14. Students who do not meet the residency qualifications Students who do not fulfil any of the criteria described above Residency qualifications Please refer to paragraphs 31 to 42 of the YPLA funding guidance regulations at Jun11-v1.pdf A copy can also be found on the school s website at: If you need some help with completing this form, please telephone the School on: and ask for Fran Lloyd Sixth Form Administrative Support

3 SECTION 1 Student Details (please print details and complete in black ink) Name of Learner: Learner Date of Birth: Start date of courses: Tutor Group Planned end date of courses: I am applying to the fund and live away from home (Go to Section 2) or; I am applying to the fund and live with my parents/guardian (Please complete parent/guardian details below) ; Surname/Family Name Adult 1 Adult 2 First Name Relationship to applicant SECTION 2 Guaranteed Award ( 1,200 per annum). Please tick the box that applies to you, the student. If not applicable go to Section 3. I am living in care I am a care leaver I am in receipt of income support I am in receipt of Employment Support Allowance and also in receipt of Disability Allowance (If you are applying for a Guaranteed Award and have completed Section 2 please now go to Section 4) SECTION 3 Discretionary Award Targeted at young people outside of the vulnerable groups identified above and who are facing financial barriers to participation. Eligible learners can apply for a maximum of 600 to provide funds for essential course materials, equipment and transport funding. Payment levels are to be assessed using Gross Household Learner and Learner Income Bands Identified Below. Student Tier A students who have successfully claimed Free School Meals for the current academic year. Student Tier B Students whose household income is less than 20,817. o Evidence: Working Tax Credit annual statement letter from HMRC Student Tier C Students whose household income is less than 25,520 o Evidence: Working Tax Credit annual statement letter from HMRC Please indicate below which Tier you are applying for: Tier A On Free School Meals Tier B Income less than 20,817 Please turn over Tier C Income less than 25,520

4 SECTION 4 Proof of Income/Benefit Submitted Whatever you have declared in Sections 2 or 3 must be supported with evidence in order for an assessment to be made. The form below is to be filled in by the student if living independently, or by the parents/guardians who are mainly responsible for the student making the application for a bursary. This is a necessary requirement for the assessment of the student s eligibility and the size of any discretionary bursary. The tables below show the evidence you will need to bring with this application form to enrolment. Please tick the ones you are providing. Household Income: Type of Income Evidence Required Tick if Supplying Annual Salary Income Support Job Seekers Allowance Employment Support Allowance Incapacity Allowance Carer s Allowance Any other benefit Working Tax Credit Child Tax Credit Grants or bursaries etc Disability Living Allowance Any Other income P60 for tax year , or last week in March 2014 payslip or month 12 (March 2014) payslip or Working Tax Credit Award Notice marked Working Tax Credit Award Notice marked Must be for full year and not partial awards (FULL AWARD NOTICE) Working Tax Credit Award Notice marked Must be for full year and not partial awards (FULL AWARD NOTICE) Relevant paperwork detailing entitlement and amount paid Relevant paperwork SECTION 5 Bank Account Details Cheques will only be made payable to students and as such they must have their own account. Please indicate if Yes/No below: I have a Bank Account in my own name I do not have a Bank account in my own name Please turn over

5 SECTION 6 Further Information Please give any details below of any other circumstances that you would like us to know about to help with your application Privacy notice The information that you provide on this form will be used to assess student eligibility for a Bursary payment. This information may be shared with other organisations for administration and statistical purposes; these could include the Young People s Learning Agency for England, the Department for Education, Derbyshire County Council. Belper School & Sixth Form Centre is registered under the Data Protection Act SECTION 7 Declaration Please read the declaration below carefully before signing: 1. I/We declare that the statements made on this form are true and to the best of my/our knowledge and belief are correct in every respect. I/We undertake to supply any additional information that may be required to support this application. I/We understand that if I/we refuse to provide information relevant to this claim the application will not be accepted. I/We also undertake to tell the school of any change in circumstances in writing. I/We agree to repay the school in full and immediately any sums advanced if the information I/We have given is shown to be false or deliberately misleading. 2. I/We am/are aware that the funding covers only this school year and that I/We must reapply next year; there is no guarantee that funding will be received for future years even if the student is eligible for the current year. Signed (Student): Signed (Parent 1 or Guardian 1 named above): Signed (Parent 2 or Guardian 2 named above): Date: Date: Date: Please note: Applications for 2014/15 should be returned to the Main School Office by Friday 10 th October 2014 at the latest. Applications after this date will be welcome and will be considered in the light of funds available in January with a closing deadline on the 23 th January 2015.

6 For School use only: Date Received: Evidence Supplied: Bursary Approved: Yes or No Guaranteed Award or Discretionary Award* Authorised By: Date: Tier: A B C First payment made date: Amount of Award Student has met the Commitment conditions Student has not met the Commitment Condition Additional Notes: