16-19 Bursary Application Form - St Edmunds Catholic Academy

16-19 Bursary Application Form
A bursary is funding that you, or your education or training provider, can use to pay for things like:
- Uniform books and other equipment for your course
- Travel costs
- Educational trips
There are 2 types of 16 to 19 bursary:
- Bursary for students in vulnerable groups
- Discretionary bursary
Bursary for students in vulnerable groups

You could get a bursary worth up to £1,200, depending on your circumstances and benefits. You may be able to get a bursary if at least one of the following applies:
- you’re in or were recently in local authority care
- you get Income Support or Universal Credit because you’re financially supporting yourself
- you get Disability Living Allowance (DLA) in your name and either Employment and Support Allowance (ESA) or Universal Credit
- you get Personal Independence Payment (PIP) in "your name" and either ESA or Universal Credit
Discretionary bursary

You could get a discretionary bursary if you need financial help but do not qualify for a bursary for students in vulnerable groups. Our Academy decides how much you get and what it’s used for.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
What is your family circumstances? Please explain if Single Parent, Both Parents at Home, In Care etc*
SECTION 2

16-19 GUARANTEED BURSARY
This information is about you - as a SIXTH FORM students.

If this relates to "your own" personal situation, please:-

1. Tick the box that is appropriate to you
2. SKIP the next question.

If this section is not for you, then please choose NOT FOR ME below and go to the next question
PLEASE NOTE : A student receiving access to the Vulnerable Bursary CANNOT apply for the Discretionary Bursary.*

I am living in CareI am a Care LeaverI am in receipt of Disability Living Allowance (DLA) or Personal Independence Payments (PIP)None of the above
SECTION 3

16-19 DISCRETIONARY BURSARY

You MUST live permanently in a household with parents/guardians/carers where the family's annual taxable income DOES NOT exceed £25.521
...... and/or ONE of the following (please tick relevant boxes below)
If you are NOT in receipt of any of the items below but reside in a household which has a totale household taxable income of less than £25,521 for the tax year*

Universal Credit Payment (evidence required - last 3 months statements - all pages)Income Support (entitlement letter covering last years period required)Jobseeker's Allowance (entitlement letter covering last years period required)Employmenet and Support Allowance (entitlement letter covering last years period required)Asylum Seekers Support (supporting letter from Home Office required)Pension Guaranteed Credit (evidence of Guaranteed Element of State Pension Credit)Child Tax Credit (Family in receipt of Child Tax Credit Award Notice letter required)Working Tax Credit (Working Tax Credit Award Notice required)Household Income (under £25,521 - copy wage slips required from parents/guardians/carers)Employment wages
Which level are you?

Level 1 Discretionary Bursary - Total income is equal (or less than) £16,190Level 2 Discretionary Bursary - Total income is more than £16,190 but less than £20,817 (Pupils on Free School Meals in Year 11 are entitle to apply under Level 2)Level 3 Discretionary Bursary - Total income is more than £20,817 but less than £25,521 (Pupils on Free School Meals in Year 11 are entitle to apply under Level 2)
How many siblings are in the household that are UNDER 18 years old (including you?)*
SECTION 4

Exceptional Circumstances

If you do NOT qulaify for an award under the above criteria, you may still apply if you can prove that your family circumstances are putting you under financial difficulty (Proof of income or hardship will be asked for if agreed) See our Policy document for further information on our Sixth Form Website)
Do you feel this applies to you?*

Yes I do qualify under "Exceptional Circumstances"No
SECTION 5
Please read the declaration below carefully and tick the boxes*

We have read and understood the bursary fund policy supplied with this application form.We confirm that the information given on the application form is true and correct.We undertake to inform the school of any alterations to any of the particulars in writing.We agree to repay the school in full and immediately any sums advanced to me, if the information I have given is shown to be false or deliberately misleading.We understand that if we refuse to provide information relevant to the claim, the application will not be accepted.We understand that if the student leaves St Edmund’s Catholic Academy before the completion of the course, payments will cease and any advanced payments will need to be repaid to the School.We understand that payment of any award is conditional upon the student meeting his/her obligations under the School’s Bursary Policy and Sixth Form Agreement regarding attendance, performance, behaviour and compliance with all procedures.We understand that funding covers only this school academic year.
Upload Evidence to support your application - MANDATORY*

Cancelof
SECTION 6
I can confirm that me and my parent/guardian/carer agree to the above declaration*

Yes we agree
Signature*

Clear
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