Gateshead College 16-18 Bursary Fund Application Form 2022/23

Gateshead College 16-18 Bursary Fund Application Form 2022/23
For students aged under 19 on 31st August 2022 or aged 19-24 and are subject to an Education Health and Care Plan (EHC Plan)

If you need help with this form please refer to guidance notes (GN) or contact Support Funds Team. Sections marked (E) may require evidence to be attached.

To view guidance notes please click here.

1) Personal details
Full name *
Date of birth *

Day Month Year
Date
Student number
Gender *

Female Male
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Telephone *
Email *
example@example.com
Nationality *
Date of entry into the UK (if applicable)

Day Month Year
Date

2) Course details

We will consider support up to and including level 3 only
Course title *
Course type *

Full time Part time

3) Residency

You must complete this section by selecting the relevant option below:
*

a. I am a British Citizen. I normally live in the UK and have lived here for at least the last 3 years. b. I am a European National (or I am a child/grandchild of a European National) have settled status and have been living within the European Economic Area (EEA) for the last 3 years. c. I am a child of an EEA migrant worker (this means that your parent(s) have come to the UK to work) and have been ordinarily resident in the EEA for the last 3 years (this means your home country is within the EEA). d. I, or my parent(s), have been granted indefinite leave to enter or remain, refugee status or discretionary/exceptional leave to enter or remain or right of abode in the UK or humanitarian protection e. I am an asylum seeker.
Please upload evidence here:

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5) Income

Provide evidence of benefit/allowance or household income – NOT for both (GN) (E)
Please tick the box if you or your parent(s)/carer(s) claim any one of these benefits (GN) (E) *

Income Based Jobseeker's Allowance Income Support Employment and Support Allowance (income related only) Guaranteed Pension Credit Gateshead College free meals (No further income evidence needed if supplied evidence with free meals app) Universal Credit (as only source of income eg jobseeking) None of the above

Please upload evidence here: *

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6) Personal Statement

Explain below why you are facing financial difficulties. If you do not complete this section, your application may be rejected. (GN)
*

7) Travel
Are you in receipt of travel support from: *

Local Authority Concessionary Pass Job Centre Plus None of the above
If yes to the above, please upload evidence here: *

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Travel support (only awarded if you live more than 3 miles from your place of learning)
What main method of transport do you use in order to attend college? *

Bus Metro Private/car Not applicable/live less than 3 miles away
If you selected Bus, what is the name of the bus company? *
How many days per week do you attend College? (include work placement – you need to provide evidence of your placement) *
Please upload evidence of work placement if applicable to above question.

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8) Your bank details

(any funding will normally be paid into this account)
Full name of Account Holder *
Name of Bank/Building Society *
Sort code *
ex: 00-00-00
Account number *
To confirm bank details are correct please enclose evidence of your bank account such as a letter or bank statement.

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9) Disabilities or Caring Responsibilities
Do you have any disabilities, caring responsibilities or any other circumstances that may affect your ability to attend your course or that you feel the College should be aware of when assessing your application for financial support?
If yes, please give details here:
We require this information to make sure that you are receiving the appropriate support, and to share with our Learning Support Team for consultation if you require special transport arrangements or any special equipment or adaptations.

10) Student declaration

Please read carefully and sign where indicated
- I declare that the information on this application is complete and accurate
- I understand that if I submit false information, or fail to give complete information, financial assistance will be withdrawn, and that all awards are subject to funds being available and Gateshead College reserves the right to reduce or refuse any requests if they are deemed excessive or if funds are limited
- I understand that it is my responsibility to inform the DWP/Jobcentre Plus if I receive an award for living costs or housing costs that are already being covered by welfare benefits
- I understand that all awards are subject to confirmation of attendance (92%), acceptable behaviour which means adhering to the Student Code of Conduct and the funding being available
- I understand that if I use fraudulent methods to obtain financial support, the College disciplinary procedure will apply or we may refer matters to the Department of Education or the Police
- I will provide any additional information which may be required
- If successful with my application I agree to repay, in whole or in part, at the discretion of Gateshead College, the award made to me if, in the view of the College I withdraw from my course without good reason, and I agree to Gateshead College making payment(s) to a third party where appropriate
- I understand I may be requested to return items purchased on my behalf, or purchased with an award, to the College, on completion of my course
- I will inform the Support Funds Team immediately of any change in my circumstances at any time which might affect my entitlement to support
- I have fully read and agree to the terms and conditions supplied with the application form
- I understand, if any information I provide raises a concern regarding safeguarding, I may be contacted
I understand that this bursary may be awarded from the 16-18 Bursary Fund or Gateshead College Foundation as determined by available funds.

Gateshead College does not accept any liability for any activities, actions or the purchase of goods or services relating to awards made from discretionary funds. Gateshead College acknowledges that individuals are different and have different needs. We actively seek to promote equality of opportunity and we will make appropriate arrangements or adjustments to assess equity of access to participation and funding.

If you want someone else to be able to speak to us about your application or award (for example, you may want the award explained to a family member) please give us their details below otherwise, we will only discuss your award with you.
Full name:
Relationship to you:
I give my consent for Gateshead College to process personal data contained in this application and where necessary, share this information with relevant staff in order to assess an appropriate award, and understand that the information on this form will be used for statistical purposes and may be used for the detection of fraud. We will protect your data in line with our Privacy Notice (available on our website) and promise not to give your data to anyone else.
Student Signature *

Clear
Name *

First Name Last Name
Date *

Day Month Year
Date
Should be Empty:

	Weekly/monthly	Notes
Salary 1
Salary 2
Working Tax Credit (not child tax credit)
Universal Credit (paid in conjunction with salary)
Other income (please state in second column)
Total

	Name	Relationship to you	Age
1
2
3
4
5
6

Gateshead College 16-18 Bursary Fund Application Form 2022/23

1) Personal details

2) Course details

3) Residency

4) Personal status

5) Income

6) Personal Statement

7) Travel

8) Your bank details

9) Disabilities or Caring Responsibilities

10) Student declaration