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