APPLICATION TO THE FINANCIAL SUPPORT FUND 2015/16 FROM PLYMOUTH UNIVERSITY

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1 APPLICATION TO THE FINANCIAL SUPPORT FUND 2015/16 FROM PLYMOUTH UNIVERSITY Welcome to the Plymouth University Financial Support Fund application. Please ensure that you read the following information, as well as the full guidance notes which are available here: before you start completing this form. This will help you to understand more about the fund, how to complete your application, and will give you an idea whether you are likely to qualify for help from us. The University will only normally consider one Financial Support Fund application in each academic year and the opening period for the year will be from 1st October 2015 to 3 rd June Please note that FINAL YEAR students must submit their completed and fully documented applications by 13 th May 2016 otherwise we will be unable to consider your request for a Standard Award. Only applications received with full and complete documentation within the opening period will be accepted. If full evidence is not provided by the deadline, your application will be closed and no assessment will be undertaken. The support available is intended to help students who have higher than average costs due to either having a disability, dependent children/adults, exceptional circumstances or for those who are vulnerable and are facing financial hardship. The Financial Support Fund should not be depended upon as a sole source of income, and will not necessarily cover a shortfall in funding. Awards are only ever intended to be a contribution towards costs, and will therefore not necessarily cover all your additional financial needs. All applications are assessed using information that is unique to you, and this means that the outcome of your application or the level of assistance awarded cannot be compared to that of any other student or discussed by us. Please be aware that submitting an application for support does not in itself guarantee an award. Amounts awarded are subject to rigorous assessment, availability of funds and volume of applications; please be aware that this can influence the amount you receive and you will not necessarily receive the same level of award as in any previous applications. We aim to assess your application within 28 days of receipt, on the condition that all required documentation is supplied at submission, and will contact you once completed.

2 Payments will be made into your designated bank account and your award letter will be ed to you, detailing the outcome and any payment date. All correspondence will be sent to your University address and it is your responsibility to keep us updated if you are awaiting evidence to be sent to you by a third party. Please note that in completing this application, you are applying for a STANDARD AWARD from the Plymouth University Financial Support Fund. NON STANDARD (EMERGENCY) AWARDS, are only considered in exceptional and unforeseen circumstances, NOT simply because you have run out of money. If you feel that this is the case, and that you need to apply for a NON STANDARD AWARD, please contact studentfunding@plymouth.ac.uk to briefly outline the reason for your request and to obtain an application form. Please return the fully completed form and evidence to: The Student Funding Unit, 4 th Floor Nancy Astor Building, Plymouth University, Drake Circus, Plymouth PL4 8AA. PLEASE BEGIN YOUR APPLICATION HERE 1. PERSONAL DETAILS - FOR ALL APPLICANTS TO COMPLETE Student number Your title Your first name (in full) Your family name (in full) Contact telephone number Term-time address including postcode o Mr o Mrs o Miss o Ms Other please state University address Date of Birth (dd/mm/yyyy) Your age on 01/09/15 Nationality Residency status years o Home (UK) Fee o Overseas Fee

3 Tell us about where you live, is this: Do you share all household expenses? Do you maintain 2 homes? o Alone o With your spouse or partner o In shared accommodation o With your parents or guardian o Yes o No o Yes o No If you have answered YES, please can you tell us a bit more about this. 2. ELIGIBILITY - FOR ALL APPLICANTS TO COMPLETE Please tell us if any of these o I am a postgraduate student (excluding PGCE) apply to you? o I am an International student Please tell us which of these apply to you? Have you applied for your full entitlement of your statutory support package from SFE? o I am a European student o I am a full time UK (Home) student o I am a part-time UK (Home) student o I am a PGCE student o N/A I am not eligible for Student Finance If you are not eligible for Student Finance, please can you briefly explain why Have you received the first instalment of your statutory support i.e Loan, Grant, NHS bursary Are you applying for financial help because your statutory support has been delayed? o N/A If you have answered YES, please DO NOT CONTINUE with this form. You should instead contact the Student Funding Unit to request a Short Term Loan. You can retain this form and submit an application when you have had the first instalment of your student funding.

4 3. COURSE DETAILS - FOR ALL APPLICANTS TO COMPLETE What is the title of your course Faculty/ Department Are you studying o Full time o Part time When did you start your course? (dd/mm/yyyy) Part timers only- How many credits are you taking this year? What year are you studying? Is this your final year? Is this a repeat year? Have you been on a previous HE course? If YES, do you already hold an honours degree? Is this a placement year? If YES, is it a paid placement? If YES, please provide evidence of your Honours Degree 4. FOR POSTGRADUATES ONLY (NOT PGCE) You are expected to have made a realistic financial provision for tuition fees and living costs for the whole academic year, at the onset of the course. Please tell us all annual sources of your provision Earnings o Grant o Sponsorship o Loans o Parental contribution o Postgraduate Scholarship Scheme o Other - please tell us about this o TOTAL EXPECTED FINANCIAL PROVISION FOR THE YEAR o

5 5. YOUR FAMILY - FOR ALL STUDENTS TO COMPLETE. Please tell us about the family who you live with or those who live elsewhere that you financially support. Do you have a partner? If YES, is your partner dependent on you? Do you have any children living with you who are financially dependent on you? NAME If YES, please can you list their details below, and provide documents to support this. RELATIONSHIP TO YOU AGE Do you have any children living elsewhere who are financially dependent on you? NAME If YES, please can you list their details below, and provide documents to support this. RELATIONSHIP AGE TO YOU 6. DISABILITY/MEDICAL CONDITION/LEARNING DIFFICULTY - FOR ALL STUDENTS TO COMPLETE Do you have a disability, medical condition or learning If YES, please provide some brief information below difficulty?

6 Have you applied for the Disabled Students Allowance? If YES, please can you provide documentary evidence of this. Do you wish to apply for any financial assistance towards special equipment/materials which are NOT covered by DSA, or for assistance towards the cost of a diagnostic test i.e. Dyslexia test? Please note that these tests will not be automatically covered. If YES, please can you provide details of these below and provide evidence of costs. WHAT DO YOU REQUIRE? HOW MUCH WILL THIS COST? 7. DEBTS TO THE UNIVERSITY - FOR ALL STUDENTS TO COMPLETE Please note that if you qualify for an award, we will automatically pay off any outstanding Short Term Loans from this academic year to date of this application. Do you have an outstanding Short Term Loan debt for the current academic year? If YES, please can you tell us how much you still owe? 8. BANK DETAILS/BUILDING SOCIETY ACCOUNTS - FOR ALL STUDENTS TO COMPLETE Please provide 3 months recent statements for ALL of yours, and your partner s (if you have one) accounts including savings as shown below. Name of Bank/Building Society/Credit Card Current Balance Agreed overdraft limit

7 9. TRAVEL COSTS - PLEASE COMPLETE only if you incur travel costs that are not reimbursed and if you DO NOT live in walking distance of the University, or are unable to do so. Please provide evidence of your travel costs During the academic year, on average I have to pay to travel to University I travel by o Once a week o Twice a week o 3 times a week o car o train o bus o 4 times a week o 5 times a week o taxi o another method please tell us about this below On average my WEEKLY travel costs me If you live in walking distance of the University but are unable to do so, please can you briefly tell us why this is: FOR STUDENTS WITH COURSE RELATED PLACEMENT COSTS ONLY How many weeks a year will you spend on placement? How much a year will you spend on placement travel costs? Are your travel costs to placement O FULLY REIMBURSED O NOT REIMBURSED AT ALL O PARTLY REIMBURSED please tell us more about this below 10. PAYMENT BY BACS FOR ALL STUDENTS TO COMPLETE. Please tell us where you would like your award to be paid, if you qualify. Your student number Your full name Bank/Building society name Account number Sort Code number If you no not want to be paid o I request payment by cheque by BACS please indicate here

8 11. PERSONAL CIRCUMSTANCES - FOR ALL STUDENTS TO COMPLETE This is your opportunity to give us a broader understanding of your situation, so please ensure that you include as much relevant information as possible. PLEASE REMEMBER TO SUPPORT YOUR STATEMENT WITH DOCUMENTARY EVIDENCE.

9 12. BUDGET PLANNER FOR ALL STUDENTS TO COMPLETE it is really important that you put an entry into every box that requires an amount, so please put a zero in any that does not apply to you, rather than leaving it blank or putting N/A. INCOME including partner s YEARLY EXPENDITURE including partner s Maintenance Grant/Special Rent /Mortgage Support Grant Maintenance Loan Rent / Mortgage arrears for current property Parents Learning Allowance Council Tax Adult Dependants Grant Gas/Electricity Childcare Grant Water NHS Social Work Bursary Telephone NHS Bursary Food / Household / Laundry TDA Bursary TV Licence University Bursary Buildings insurance PSMD Bursary Other insurances( excluding car) Disabled Students Allowance Car costs( excluding petrol) Scholarships Accredited childcare costs Professional/ Career Course related travel to University Development Loan and back Cost of returning home during Grants/Trusts holidays Savings Cost of getting to work and back Parental or Partner s Placement travel costs that you contribution DO NOT get back Your net earnings term time Tuition fees if you are self-funding Course costs i.e. Partner s net earnings books,equipment Child Tax Credit Disability costs not met by DSA Working Tax Credit ONGOING prescribed medication Child Benefit Child Maintenance Support Child Maintenance Priority debts( IVA, DMP etc.) Housing Benefit TOTAL PER MONTH Income Support PLEASE LIST BELOW ANY ONE OFF COSTS Job Seeker s Allowance ESA Disability Benefits please specify below Other income please specify below TOTAL PER YEAR TOTAL ONE-OF COSTS MONTHLY

10 13. DOCUMENT CHECKLIST ALL STUDENTS NEED TO COMPLETE. It is your responsibility to provide documentary evidence of all the information that you have told us about AT THE SAME TIME THAT YOU SUBMIT THIS APPLICATION. Please be aware that if you don t do this, we will cancel your application and return your form to you. PLEASE TICK THE BOXES TO SHOW THAT YOU HAVE ATTACHED PHOTOCOPIES OF THESE DOCUMENTS ORIGINALS WILL NOT BE RETURNED. Ensure that the amounts shown on your budget planner correspond accurately with the information on your documents. ALL STUDENTS please provide: o 3 month s bank statements for ALL accounts including savings for you and your partner (if applicable) o Evidence of accommodation costs Tenancy agreement or Mortgage statement which must clearly show your name, address and the monthly payment Please provide evidence of the following only IF APPLICABLE and already mentioned in this application: o Child Tax Credit/Working Tax Credit Award Notice please ensure this is the most recent version and that it outlines your current entitlement o Housing Benefit Award notice please ensure this is the most recent version o Social Work Bursary Award Notice o Other bursaries and Scholarships Award Notice o 3 month s payslips for you and your partner (if applicable) o Travel evidence petrol receipts, train or bus tickets covering a typical month s travel o Child Maintenance payments - this should be for payments made or received o Course related childcare costs please ensure this shows your current costs for 3 months o Compulsory field trip costs that you have to pay yourself - evidence showing that the trip is compulsory and evidence of costs o Council Tax evidence that shows your current instalments o Evidence of priority debts documents relating to IVA, DMP etc. o Medication costs evidence showing your ongoing monthly medication costs o Evidence of car costs insurance and tax o Evidence of rent arrears this can only be consider for your current property o Evidence of disability costs not met by DSA Full time UNDERGRADUATES please also provide: o SFE Student Finance Breakdown Letter this can be taken from your online personal SFE account o If NHS funded, NHS Bursary Award Letter and evidence of your non means tested Student Loan these can be taken from your online personal SFE/NHS account PART-TIME UNDERGRADUATES please also provide: o Student Finance Letter showing fee and course grant OR tuition fee loan o Proof of your income wage slips, benefits etc.

11 POSTGRADUATES please also provide, if applicable: o Professional/Career Development Loan Agreement o Evidence of how you otherwise intend to fund yourself savings, parental support etc. o Evidence of receipt of Postgraduate Scholarship Scheme 14. CONFIDENTIALITY AND DECLARATIONS FOR ALL STUDENTS Applications are seen only by Plymouth University Student Funding staff. It may be necessary for additional supporting information to be sought from other University staff in order to reach a decision. Plymouth University is a data controller in terms of 1998 legislation. The Student Funding Unit follows the University policy in matters of data protection. The data requested in this form is covered by the notification provided by the University under the Data Protection Act. Personal data will be used solely in the department for statistical purposes and electronic record keeping. The data will not be passed to any third party without your consent, except when the University is required to do so by law. Any formal enquiries concerning the use of data here should be addressed to the Head of Gateway Services. Signature I declare that the information that I have given on this form is correct and complete to the best of my knowledge. I understand that giving false information will automatically disqualify my application and may also lead to Plymouth University Disciplinary Procedures, resulting in possible expulsion from the University, and I further undertake to repay any grants obtained by me, as a result. Print your name Your signature Date Please do not submit your application until you have checked that your information is correct, and that you have attached all the relevant documents. Failure to provide full documentation will result in automatic rejection.

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