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Student Welfare and Assistance Scheme

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					The student assistance fund is funded by the Department of Education and Science with assistance from the European Social Fund under the National Development Plan 2000-2006

Student Assistance Fund Application Form 2006-2007
This application, along with supporting documentation, should be returned to the SAF Committee, C/o Patricia Geoghegan, Computer Science and Informatics Centre, UCD, Belfield, Dublin 4. Closing Date: Thursday 15th February 2007 at 2.30pm. Incomplete applications will not be taken into consideration.

Eligible Applicants: Students currently registered at UCD for a programme of not less than one year duration leading to an undergraduate or postgraduate qualification. This Fund will be targeted at those disadvantaged students most in need.

Section A: Personal Information
To be completed by ALL applicants

Last Name:
(as on Birth Cert)

Date of Birth: Country of Birth: Address for correspondence (if different):

First Name: Home Address:

Phone: Mobile Phone:

Phone: E-mail Address:

UCD Student No.

Year of Study, e.g. 1st, 2nd, 3rd etc.

Programme Title

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Section B: Financial Supports e.g. Grant, Awards, Scholarships, etc
To be completed by ALL applicants

Local Authority Higher Education Grant
Are you in receipt of a Local Authority Higher Education Grant? (please tick) If yes, please state the amount(s) Are you in receipt of the Local Authority ‘Top-up’ grant? (please tick) If yes, please state the amount of ‘Top-up’ Yes € No €

Fees (full or half) Yes € €

Maintenance

No

Total Amount of Grant received from these sources

Financial Support from UCD in 2006/07 and All other Grants, Awards, Bursaries, Scholarships, Financial Supports, etc.
(both public & private)

Have you received or are you in receipt of any financial support(s), grants, scholarships or bursaries from UCD in 2006/07 or any agent(s) outside of UCD in 2006/07? (Please tick) Yes No (provide details) If yes, please provide details below: Monies from: (Name and Address): Amount: €

Monies from: (Name and Address):

Amount: €

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Section C: Financial Information
To be completed by a parent/guardian of all applicants other than independent mature students

1. Details of Dependent Children Please give details of children (including foster children) under the age of sixteen on January 1st 2006, or over sixteen years attending a full-time programme of study at an educational institution or medically certified as permanently unfit for work. Surname First Name Date of Birth School/College Attended
………….. ………….. ………….. ………….. ………….. ………….. ………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………. …………………. …………………. …………………. …………………. …………………. …………………. …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… ……………………………………

2. Particulars of Income from Paid Employment (including self-employment) If neither parent/guardian is in paid employment, please go to 3 below
Occupation Income from employment
(e.g. PAYE- salary, wages, fees, etc.)

Total income for the year ended 31st December 2005 Father Mother Guardian Documents Required N/A

  

  

  

P21 and P60 for each. Notice of Assessment and Accounts P60 and P21

Income from self-employment Income from pension
(from former employer or pension scheme)

Notice of Assessment Income from land: profits from    and Accounts farming activities Relevant Evidence Income from any other source.    Please specify: **SEE NOTES FOR DEFINITION OF P21, P60, NOTICE OF ASSESSMENT, ETC..

3: Particulars of income from Department Of Social & Family Affairs (DSFA)
Total income for the year ended 31st December 2005 Father Mother Guardian Documents Required Current or most recent occupation DSFA –Benefit Name: ………………
N/A







P21 and Social Welfare Statement

**SEE NOTES FOR DEFINITION OF P21, P60, NOTICE OF ASSESSMENT, ETC..
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Section D: Financial Information
To be completed by independent mature applicants only
(Independent mature student = 23 years or over on year of entry to programme)

1. Details of Dependent Children
Please give details of children (including foster children) under the age of sixteen on January 1 st 2006, or over sixteen years attending a full-time programme of study at an educational institution or medically certified as permanently unfit for work. Surname First Name Date of Birth School/College Attended ………….. ………….. ………….. ………….. ………….. ………….. ………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………….. …………………. …………………. …………………. …………………. …………………. …………………. …………………. …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… …………………………………… ……………………………………

2. Particulars of Income from Paid Employment (including self-employment) If neither is in paid employment, please go to 3 below
Total income for the year ended 31st December 2005 Applicant Spouse/Partner Documents Required
N/A

Occupation Income from employment
(e.g. PAYE- salary, wages, fees, etc.)

  

  

P21 and P60 Notice of Assessment and Accounts P60 and P21

Income from self-employment Income from pension
(from former employer or pension scheme)

Notice of Assessment and Income from land: profits from farming   Accounts activities Relevant Evidence Income from any other source.   Please specify: **SEE NOTES FOR DEFINITION OF P21, P60, NOTICE OF ASSESSMENT, ETC..

3. Particulars of income from Department Of Social & Family Affairs (DSFA)
Total income for the year ended 31st December 2005 Applicant Spouse/Partner Documents Required Current or most recent occupation DSFA – Benefit Name:…………………..
N/A





P21 and Social Welfare Statement

**SEE NOTES FOR DEFINITION OF P21, P60, NOTICE OF ASSESSMENT, ETC..

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Section E: Budget Plan for the Academic Year 2006/07
To be completed by ALL applicants From September 2006 to May 2007 Income Higher Education Grant Scholarship/Bursary, etc. Contribution from Family / Spouse / Partner Social Welfare Health Board payment Part-time Work Summer Work Other, please provide details Total Annual Income € Amount € Expenditure Rent / Contribution to home Light/heat/power Books and other academic materials Travel Food Childcare Medical Expenses, e.g. doctor, dental & optical Others, give details Total Annual Expenditure € Amount €

To be eligible for assistance, total expenditure MUST exceed total income.
Notes: Frequently Asked Questions
What is a P21? A P21 is a statement of total income, tax credit and tax paid for a particular tax year. Will my P60 not suffice? No, because, you may have more than one source of income or you may be jointly assessed with your spouse which means that a P60 from one employer would not give the full information required. How do I get a P21? You should forward your Form P60 (and, if relevant, a Form P60 for your spouse) for the tax year to your district office and indicate that you require a P21. If you wish to claim any additional tax credits you should provide the necessary information e.g. certificates of interest paid, details of VHI contributions etc. Your district office will advise you if any further in formation is required. My parents are self employed, what documents are required? You need a profit/loss account and balance sheet to show income. You also need a Notice of Assessment certificate, which is provided by Revenue once your accounts have been submitted and tax has been paid. Your accountant will be able to provide the relevant information. I don’t have a P60, what do I do? If you finished working for your employer prior to December 31 st of the previous year, they would have provided you with a P45. You can submit this document along with your P21. 5

Section F: Grant Recipient Details Required for Statistical Purposes
To be completed by ALL applicants

Name of Student: Student No: Gender: Male

_________________________ _________________________ Female

Age of Student at time of Entry: Over 25 23-25 years Under 23

Please tick as appropriate:
Pre-Training Status (i.e. prior to UCD entry) Full time Education Employed (prior to commencing training/studies) Long-term unemployment (more than 12 months) Unemployed (less than 12 months) Not available for employment (more than 12 months) Not available for employment (less than 12 months) Please Tick One Pre-Training Educational Qualification No qualification Group Certificate Intermediate/Junior Certificate Leaving Certificate Third level Qualification Postgraduate Qualification Please State (MSc, PhD etc) Please Tick One

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Section G: Please State Here: Why funding is required
To be completed by ALL applicants

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Section H: Please state below any questions relating to this application that you would like answered
Optional Section

Check List O I have read the ‘FAQ’ and the ’General Information and Guide to Completing an Application’. O I have not included the information cover page with this application. O I have not included receipts with this application. O I have included all the relevant documentation (see Sections C.2/C.3 or D.2/D.3) in support of my application as per the ’General Information and Guide to Completing an Application’. O I understand that all related queries should be stated in the allocated area above or directed to via email.

IN ACCORDANCE WITH EU (ESF) REQUIREMENTS SUCCESSFUL APPLICANTS WILL BE REQUIRED TO PROVIDE OFFICIAL RECEIPTS IN RESPECT OF ANY FUNDING AWARDED TO THEM.

Declaration Please note that the declaration has to be signed by both the applicant and his/her parent/guardian, except in the case of independent mature students, who should sign at applicant only. I/we understand that existing UCD records may be accessed in order to assist the processing of this application. I/we certify that the information supplied is correct and complete.

Signature of parent/guardian: ______________________ Date: _____________________ Signature of applicant: ___________________________ Date: _____________________

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