16-18 Bursary application form

Please send your completed application form to Customer Services at your own campus:
Wiltshire College Chippenham – Cocklebury Road, Chippenham, SN15 3QD.
Wiltshire College Salisbury – Southampton Road, Salisbury, SP1 2LW
Wiltshire College Lackham – Lacock, Chippenham, SN15 2NY
Wiltshire College Trowbridge – College Road, Trowbridge, BA14 0ES
16-18 FE Bursary
APPLICATION FORM 2014/15
Private and Confidential
PLEASE READ THE ATTACHED GUIDANCE NOTES BEFORE COMPLETING THIS FORM
Applications will be considered from July 2014. Funds are not guaranteed and are subject to
availability. Students are recommended to apply early for support.
Date received:
Person code:
FOR OFFICE USE ONLY
Assessed by:
Bursary Award 1st payment on ______ of £
__ further payments of £
Date of approval
Residential Trips £
Equipment/Uniform/Books/ £
Travel £
Other
Free College Meals £
Please ensure that all boxes are completed fully and enclose evidence of income
1. PERSONAL DETAILS Please use BLOCK CAPITALS
First Name
Last Name
Date of Birth
Age on first day of course
Address
Daytime Tel
Post Code
Mobile Tel
2. NATIONALITY & RESIDENCY
Have you been a permanent resident in the UK or EU for the past 3 years?
Yes
No
If NO, please provide evidence of your current immigration status (copy of your passport)
Are you an Asylum Seeker? (if yes, you will be required to provide proof)
Yes
No
3. HOUSEHOLD DETAILS
Do you currently :
Live at home with parent/s or guardians
If at home, how many children are under 18 in the
household
____________
If at home, are you living with one parent / guardian or
2 parents/guardians
____________
Live with a partner or spouse?
Live on your own or in shared accommodation?
Are you a Carer?
Yes
No
Who do you care for?
4. COURSE DETAILS
TITLE OF ALL COURSES YOU ARE
STUDYING
Which year of the course are you now on?
First Year
Second Year
COURSE CODE(S)
if known
Full /Part time
FT
PT
FT
PT
Start Date if
not September
No. of
weeks
How many days are you required to attend college each week?
One
Two
Three
Four
Five
Is this course an Apprenticeship, or part of a Government Training Scheme?
Yes
No
5. COURSE RELATED COSTS What are the financial barriers to studying at college which you feel you
most need support with? Please number in order of priority with 1 being the most important.
Free College meal
Other – please say what or explain your circumstances
Course related clothing/uniform
Course equipment/ books
Course related trips
Travel to and from college
(You must complete a travel application too)
Childcare (please apply to Care to Learn)
6. TUTOR RECOMMENDATION
If you are making an application after your course has started, please ask your personal tutor to complete
the following: (if you apply before September, this does not need to be completed)
I confirm that the student named overleaf is attending regularly and is fully committed to his / her
course.
Additional comments
Name of Tutor
Signed
Date
7. STUDENT BANK DETAILS Awards may be paid into your bank account. Please enclose a copy of an account
statement or letter from your bank or building society showing your name, sort code, account number, roll number (if
applicable) and your home address. This information is used to verify your details are correct, as funds paid by BACS to an
incorrect account cannot be refunded and you may lose this money.
PLEASE ENSURE THESE DETAILS ARE CORRECT, AS FUNDS PAID BY BACS TO AN INCORRECT ACCOUNT CANNOT BE
REFUNDED AND YOU MAY LOSE THIS MONEY
Name of Account Holder
Name of Bank and branch
SORT
CODE:
ROLL NUMBER
(IF YOU HAVE A BUILDING SOCIETY ACCOUNT)
ACCOUNT
NO.
8. HOUSEHOLD INCOME- Please tick ONE of the following statements in A, B or C and attach the required
evidence to this form. Households with incomes over £21000 are not eligible to apply to this fund.
Category A (tick one only)
I am a ‘looked after child’ supported by Social Services
I am a ‘care leaver’
I receive income support (or Universal Credit) in my name
I have a disability and receive both Employment Support Allowance and Disability Living
Allowance/Personal Independence Payment
You must provide either a letter from social services, OR a letter confirming your entitlement to Income Support
or Employment Support Allowance (not more than 3 months old) . If you don’t have this, the Job Centre can
stamp the box below.
OR
Category B
I am living independently either on my own or in shared accommodation and I am not on any benefits
You must provide evidence of your income. Allowance from parents, payslips from a part-time job, or proof of
savings. The evidence must not be more than 3 months old.
OR
I live with my parents/guardian and they are in receipt of either Jobseekers Allowance, Employment
Support Allowance, Pension Credit, Income Support or Universal Credit.
You must provide a letter confirming your parent/guardian entitlement to one of the above benefits (not more
than 3 months old) or a tax credit award notice for 14/15. If they don’t have this, the Job Centre can stamp the
box below.
OR
Category C
I live with my parents/guardian. They are not on benefits, but have an annual household income of
less than £21,000.
Please attach your parent/guardians 14-15 Tax credits Awards Notice. If they do not have one, they will need to
supply copies of their pay slips (last 2 months) for each parent/guardian.
WE CANNOT MAKE AN AWARD UNTIL SATISFACTORY EVIDENCE OF HOUSEHOLD INCOME IS RECEIVED
Please ask the Job Centre to sign, date and stamp the form to confirm that
you are currently receiving benefits as above (if you have not attached an
official letter confirming your benefit)
I confirm that
Official Stamp
will be in
receipt of
(name of benefit)
at the start of the course on
(start date of course)
Name of Officer
9. DECLARATION to be signed by student AND by the parents / guardian(s) or spouse / partner
I confirm that all information supplied on this application is correct and I understand that the College
has the right to reclaim any funding if I am found to have provided incorrect information or if I do not
complete my course. I understand that information from this form may be recorded electronically in
accordance with the Data Protection Act and authorise the college to seek independent confirmation
of my personal circumstances.
Student Signature
Parent /Guardian / Spouse / Partner’s signature
Date