ACCESS TO LEARNING FUND 2010-11

							                                      APPLICATION FORM
                      ACCESS TO LEARNING FUND 2012/13
                         For assistance completing this form please refer to the
                          Explanatory Guide at www.wlv.ac.uk/moneymatters
                        Applying for Access to Learning Fund?
No              Yes           Complete ALL sections - Parts 1 to10
You can apply for ALF if you are:
        A registered student at the University of Wolverhampton
        Classed as a “home student”
        In proven genuine financial hardship
And
        Have taken up all statutory support that is available to you i.e. Maintenance Loan/Tuition Fee
         Loan/NHS Bursary (for undergraduate students).
        If part-time and started studying before September 2012, be studying at least 60 credits or 50%
         (25% for students with a disability) of an equivalent full-time programme.
        New part-time students who commenced their study in September 2012. You must have applied for
         your Tuition Fee Loan and must be studying at least 25% of the full-time equivalent

     Applying for Additional Fee Support Scheme? For students who
                commenced study before September 2012
No              Yes           Complete Parts 1, 4, 5 and 10

You can apply for AFSS if you are a registered undergraduate part-time ‘home student’ and have:
    Taken up all statutory support that is available to you i.e. Part-time Course and Fee Grant
    Registered to study at least 60 credits or 50% (25% for students with a disability) of an
      equivalent full-time programme.
    Please refer to Explanatory Guide at www.wlv.ac.uk/moneymatters for full terms and
      conditions.

            How did you hear about the Access to Learning Fund?
(please tick -Your comments are valuable as they will help us to improve our service)
                                                   
Prospectus                                                                  Comments
Gateway Reception
University of Wolverhampton Website
Poster/Flyer/Notice Board
From a friend/fellow student
Freshers’ Fayre
Open Day
Students’ Union
Other (please specify)



Are you the first in your family to attend Higher Education?       Yes                    No
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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
Submitting your application

We require ALL supporting documents in order to carry out our assessment. Documents
required for evidence are listed below each section; please provide PHOTOCOPIES of
these as we are unable to return originals. If your application is incomplete we will
contact you via email so check regularly. You will have 28 days to respond to this
request. If this information is not received by the requested date your application will be
rejected.

Your completed application, together with photocopies of the evidence required should be
returned to The Gateway (ALF). Please mark your envelope “Private and Confidential” and
ensure that you use the correct postage as insufficient postage could delay delivery by 4
– 6 weeks.

Our address is:

The Gateway (ALF)
Room MD085
University of Wolverhampton
City Campus
Wulfruna Street
Wolverhampton
WV1 1LY
T : 01902 32 1070
F : 01902 32 2972
E : ALF4students@wlv.ac.uk
W: www.wlv.ac.uk/Moneymatters

The Access to Learning Fund Panel meets weekly to decide cases and we aim to process all
complete application forms within 4 working weeks. If the Panel or an assessing officer
requires more information to make an accurate decision however, or if information is missing or
ambiguous, it may take longer to give you a decision.

You will be notified of the Panel’s decision via email. An Explanatory Guide is available from
our website which explains how the assessment was made and what to do if you disagree with
this decision. Awards may be made by instalments and may be subject to you seeking financial
advice from a Money Adviser in the Advice & Support Centre. Their telephone number is 01902
322038. We may ask to see evidence of this before further awards can be released. This should
be clear from your award letter, however if you do not understand how the decision has been
made, please contact the ALF team in The Gateway at the above address.

If resources permit, we may be able to help continuing students from the Access to Learning
Fund over the summer period (2013). Details will be publicised before the end of the academic
year.




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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
 Date of Receipt                                                                  File No: ……………


Part 1: Your Personal Details
                             Student number
                               Title (please circle)   Mr          Mrs   Miss      Ms       Other
                            First names (in full)
                     Surname (in full)
 Full correspondence address
 (please inform us directly if you change
 address after submitting application)
 Contact telephone number                              Landline:                  Mobile:
 E-mail address for correspondence                                                 @
 NB: You will be notified of the decision via
 this email.
 Your gender               (please circle)             Male              Female
       Date of birth (dd/mm/yyyy)                                        Age on 1/9/2012            Years

Part 2 Living Arrangements
 (please circle all that apply)

 Live alone (no children)                       With Partner/Spouse             With Partner/Spouse
                                                                                & Child/children
 Shared accommodation                           Alone with Child/children       With Parents or Guardian


 Part 3: Your Dependants
  Full Name                                            Date of Birth Relationship to you Is this person
                                                                                         financially dependent
                                                                                         on you? Yes / No




  (if you need to, continue on a separate
  sheet and attach it to this form)

    Documents required for evidence - please provide photocopies of:
       Tax Credit Notification (all pages)
       Child Benefit Letter




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 CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
Part 4: Course Details

 Course Title

 Academic School/Department
 (or name of College if franchise student)
 Are you:     (please circle all applicable) Undergraduate     Postgraduate Full-time Part-time
             Campus e.g. Walsall, City
 Course start date (mm/yyyy) (please circle) September          January/February 20
                                               st    nd      rd
 Year of study – is this your:               1     2       3        4th     5th     Final Other
                               (please circle)
 Is this a repeat year?        (please circle)   Yes           No
 If you are on a Sandwich Course is this a                              Is it Paid?          Yes        No
 placement year?               (please circle) Yes            No        (If unpaid please explain why in your personal
                                                                        statement)
 Do you have to undertake compulsory             Yes          No
 fieldwork or have extra course costs?           (If yes please complete the ‘Extra Course Costs Form* available from
                                                 The Gateway or online to download. This will need to be signed by your tutor)

  Documents required for evidence - please provide photocopy of:
     Part time Tuition Fee loan from Student Finance England if part time studies
       commenced in September 2012
     Breakdown of Course Costs Form (if applicable) – signed by Tutor



 Part 5: Additional Fee Support Scheme (Undergraduate part-time students who
 started before September 2012 only)
 Please tick what statutory support you are receiving and specify the amount

                               Fee Grant (paid directly to the College/University by the SLC)

                               Course Grant

 How much are your tuition fees for 2012/13?

 NB: The AFSS cannot guarantee to pay the full balance of fees owed by you so you must make
 arrangements to pay any fees that remain outstanding after this assessment has been finalised. For
 further information go to www.wlv.ac.uk/howtopay

    Documents required for evidence - please a provide photocopy of:
       Student Finance England notification letter (all pages)




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 CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
 Part 6A: Student’s Income                                                     £
  Maintenance Grant /Special Support Grant
  University ‘Start Right’ Bursary
  (Students starting from 2006 onwards)
  National Scholarship Programme
  (students starting from 2012 onwards)
  Maintenance Loan
  NHS/Social Work/TA Bursary
  Part-time Course Grant (students commencing study before
  September 2012)
  Parental/Partner contribution
  Parents Learning Allowance
  Adult Dependants’ Grant
  Childcare Grant This is available throughout the year except for Final
  Year students when it’s paid until the last day of the final term.

  Disabled Students’ Allowance
  Professional and Career Development Loan
  Net Earnings
  Income Support / Employment Support Allowance
  Job Seekers Allowance
  Housing/Council Tax Benefits
  Child Benefit
  Child Tax Credit
  Working Tax Credit
  Disability Benefits (specify)
  Other income: (e.g. CSA/Maintenance payments, Savings etc.)
                          Partner’s income from ALL sources                =
                                                               TOTAL (7A)
  etc. – specify) required for evidence - please provide photocopies of:
   Documents
     Student Finance England Notification form for undergraduate full and part-time
        students (all pages)
     Evidence of fees paid/payment plan
     NHS Bursary Notification
     Career Development Loan letter
     Benefits letter from DWP (for Housing, JSA, Income Support etc.)
     Savings
     Payslips




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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
 Part 6B: Student’s & Partner’s Expenditure                                            £
 Composite Living Costs i.e. expenditure on food, clothing, household bills
 and socializing.

 Rent

 Board (if living with parents/guardian)

 Mortgage

 Buildings Insurance

 Council Tax

 Childcare: Formal (must be OFSTED registered)
                                                                                Per week/month


 Informal (may be a family member/friend)
                                                                                Per week/month

 Priority outstanding debts – Rent arrears, Council Tax, Gas & Electricity
 Charges, loans secured against home, fines & maintenance orders and HP
 agreements for essential goods (such as cooker, fridge etc). If you have a
 payment plan drawn up by a Finance Adviser please include a copy.
 1st Years only – Emergency loans from ALF.

 Daily travel costs(public transport)

 Private vehicle costs
 (fuel & parking – only considered if you have children/disability)

 Private vehicle costs
 (please provide evidence of Maintenance/tax/ insurance for vehicle)
 Books/Equipment etc (Breakdown of Course Cost form available from The
 Gateway)
 Other costs (specify)
                                                                 TOTAL (6B) =

               SURPLUS/DEFICIT: Income - Expenditure (6A – 6B)

   Documents required for evidence please provide photocopies of:
     Tenancy Agreement, Mortgage Statement or signed Board letter from
       parent/guardian
     Childcare receipts and costs
     Council Tax Letter
     Payment Plan (for priority debts)
     Car Insurance

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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
Part 7: About Your Needs

Do you have a disability or chronic medical condition?
(if yes please give details below)                                 Yes          No
                                                                  (please circle)
Are you or have you ever been in care?                             Yes          No
                                                                  (please circle)

Are you or have you ever lived in a Foyer Hostel?                   Yes             No
                                                                   (please circle)



  Documents required for evidence - please provide photocopies of:
      Letter from Local Authority (Care Leaver Team) or Foyer Federation
      Last 3 months’ bank statements of all accounts




Part 8: Supporting Statement
Please state below why you are in financial difficulty and why you believe your situation to be
exceptional and to merit additional support. Your application will not be considered if you do not
complete this section. (Please continue on a separate sheet if needed)




                                                                                                     -
CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
Part 9: Bank/Building Society details
If you change your bank details after making your initial application please email the
changes to: ALF4students@wlv.ac.uk. Failure to do so will result in a serious delay in any
payments that may be due to you.

  If you are successful your award/instalments will be paid directly into the account
  stated below. Further instalments may be subject to you seeking advice from a
  Money Adviser in the Students’ Union or Citizens’ Advice Bureau.



  Name of Bank/Building Society              Account Number                       Sort Code




     Documents required for evidence please provide photocopies or online statements
     of 3 months for any of the following that apply:
       Account where your award (if successful) is to be paid into
       Partners account/s (if applicable)
       Account where child benefit and child/work tax credit is paid into
       Any other accounts you or your partner hold such as Savings, ISA, Credit
          Union etc.

         Please explain any credit or debit over £100 that appears on your
                                    statements.


These statements must be consecutive and recent, show your name, bank details,
transactions and bank balance – mini statements are not acceptable but we can accept
online statements and scanned items.

      Applications submitted without relevant bank statements will not be
                                 considered.



Data Protection Act 1998
The University of Wolverhampton is a data controller in terms of the 1998 legislation. The Gateway follows
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 records keeping.

The data will not be passed to any other third party without your consent, except when the University is
required to do so by law. Any formal enquiries concerning the use of data noted here should be addressed
to The Gateway.




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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
Part 10: Declarations

I certify that to the best of my knowledge, I meet the following conditions: (please tick the relevant boxes)

SECTION A

               i) I am a UK national/British citizen; or

               ii) I am settled* within the United Kingdom (UK) (i.e. I have the Right of Abode in the
               UK or have been awarded Indefinite Leave to Remain or
               iii) I have been recognised by the UK Government as a Refugee or

               iv) I have been granted Humanitarian Protection (HP) by the Home Office or

               v) I am an EEA or Swiss Migrant Worker or the family member of an EEA or Swiss
               Migrant Worker

               (please tick if you intend to continue working while studying), or

               vi) I am an EU national who has been ordinarily resident in the UK for the three years
               prior to the first day of the first academic year of my course, or

               vii) I am the child of a Swiss national, or

               viii) I am the child of a Turkish worker.

                *‘settled’ – on the first day of the first academic year of your course.
   Plus

               I fall under either (i), (ii),(iv) or (vi) above and I have been ordinarily resident in the UK
               and Islands for the 3 years immediately before the first day of the first academic year of
               my course***, or

               I fall under (iii) above, or

               I fall under (v) or (vii) above and I have been ordinarily resident in the EEA and
               Switzerland for the 3 years immediately before the first day of the first academic year of
               my course, or

               I fall under (viii) above and I have been ordinarily resident in the EEA, Switzerland and
               Turkey for the 3 years immediately before the first day of the first academic year of my
               course.

               ***None of this time was wholly or mainly for the purpose of receiving full-time
               education, or if it was, I was resident in the EEA immediately prior to this three-year
               period.
                                                                                                                -
CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED
And

              I confirm that I am registered and in attendance on the course described in this form.

              I confirm that I am supporting the children named in Part 3 of this form.

              I confirm that I am not living with a spouse/partner (if relevant).



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 disciplinary procedures resulting in possible expulsion from the University. I further
undertake to repay any grants obtained by me as a result.

NB: Third party debt declaration

The Panel may recommend that awards may be paid directly to a third party in order to clear a priority
debt or prevent court action. I agree that part or all of any award I may receive from the Access to
Learning Fund may be paid directly towards that debt.




  Your name (CAPITALS)                      Your signature                          Date




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CLOSING DATE: APRIL 12 OR UNTIL ALL FUNDS ARE DEPLETED