Gateshead College 19+ Bursary Fund Application Form 2022/23

Gateshead College 19+ Discretionary Learner Support & Advanced Learner Loans Bursary Fund Application Form 2022/23
Apply on this form if you are 19 or over on 31st August 2022

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
Age *
Student number
Gender *

Male Female
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
Are you 19 to 24 with an Education Health and Care Plan (EHCP)? *

Yes No

2) Course details
Course title *
Course type *

Full time Part time
Course Level *
How have you paid your fees? (E) *

Part paid/paid by GC Fees Support Advanced Learner Loan (Include notification letter from SLC) Fee remission (UC/JSA/ESA/Low Income or Level 2/3 entitlement) I have paid the fees myself

3) Residency
You must complete this section by selecting relevant option (GN) (E) *

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 I 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/indefinite leave to enter or remain or right of abode in the UK or humanitarian protection. e. Asylum seeker – lived in the UK for six months or longer while claim is being considered by the Home Office, and no decision claim has been made. Asylum seeker – appealed against a decision made by the UK government against granting refugee status and no decision has been made within six months of lodging the appeal. Asylum seeker – granted support under section 4 of the Immigration and Asylum Act 1999.
Upload evidence required here if necessary (see guidance notes):

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

5) Disabilities or caring responsibilities
Please give details of any disabilities, 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 We may share this information with our Learning Support Team to ensure that you are receiving the appropriate support. (GN)

6) Personal status
Please tick select the option which best describes your current circumstances. Do you live: *

With my parent(s)/guardian(s)/carer(s)? With my dependent children (lone parents only)? With my partner/spouse? Alone?

7) Income

Provide evidence of benefit/allowance or household income – NOT for both (GN) (E)
Please tick the box if you (or your partner if you have one) 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 Universal Credit (as only source of income eg jobseeking) None of the above

Please upload any required evidence here: *

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9) Your bank details

(any funding will normally be paid into this account)
Full name of Account Holder *
Name of Bank/Building Society *
Sort code *
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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11) Student declaration

Please read carefully and sign where indicated
- I declare that the information on this application is complete and accurate and I will provide any additional information which may be required
- I understand that if I use fraudulent methods to obtain financial support, the College disciplinary procedure will apply
- 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
- 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 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 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 understand that all awards are subject to confirmation of attendance (92%), acceptable behaviour and funding being available
- I understand that the Support Funds Team may discuss my award or attendance with childcare providers
- I have fully read and agree to the terms and conditions supplied with the application form
I understand that an award may be given from the 19+ Discretionary Learner Support, Advanced Learner Loans 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.

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 (use mouse or finger to draw signature) *

Clear
Date signed *

Day Month Year
Date
Should be Empty:

	Name	Relationship to you	Age
1.
2.
3.
4
5.
6.

	Weekly/monthly income	Notes/further info
Salary 1
Salary 2
Working Tax Credit/Universal Credit
Total income

	Name	Age
1.
2.
3.
4.

	Nursery	Childminder	Out of school club
Full day
Half day

Gateshead College 19+ Discretionary Learner Support & Advanced Learner Loans Bursary Fund Application Form 2022/23

1) Personal details

2) Course details

3) Residency

4) Personal statement

5) Disabilities or caring responsibilities

6) Personal status

7) Income

8) Support required

9) Your bank details

10) Childcare

This section is to be completed by Childcare Provider please ask them to complete.

11) Student declaration