Guidance You should read this before you fill in the form by asafwewe


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									Access to Learning Fund
Full time Undergraduate and Postgraduate
Application for Grant for Living Costs
Support 2009/10

Guidance: You should read this before you fill in the form.

The Access to Learning Fund is a discretionary fund which may, depending on your circumstances,
provide additional funding, on top of any grants, loans etc you get.

The fund can help in two ways.

                 ‘Grant for Living costs’ – You may get some money to help with day to day living

                 Special Request – You might get money if you have unexpected or exceptional

We expect you to have taken reasonable steps to minimise your expenditure and to have
maximised your income by taking out all funding that is available to you. This may include Student/
Maintenance Loan, Grants, Bursaries, Welfare Benefits & Tax Credits. If you are not sure what you
should be getting you may want to speak to a Finance Adviser before completing this form.

You can use this form to apply for a ‘Grant for Living costs’ – This support is means tested on the
basis of your income and that of any spouse, co-habiting partner or civil partner. We also adhere to
external guidance on how the Access to Learning Fund should be operated.

What are the basic rules?
     You must normally live in the UK
     You must be enrolled at the University
     You must have taken out the full Student/ Maintenance loan available to you
     Postgraduate students – If you are a postgraduate student you need to provide evidence you
     have made provision to pay your tuition fees and meet your living costs
     You must provide documentation confirming your income and expenditure. Further detail is
     provided on the form

   Important Information
         Under no circumstances can the fund be used to pay for full time tuition fees.
         It is important that your answers on the form are honest. If you are not sure about how to
         answer a question you should seek advice or give more detail by attaching a letter.
         Deadline – completed applications will be accepted up to a fortnight before the end
         of the final term.

   Applications can be dropped in to the Student Centre – Level One, Information Desk, or post to
                         Student Funding Team, Student Centre – Level One
                                         Teesside University
                                              TS1 3BA

   How long does it take?
   If you put your form in with all the documents needed we will try and contact you in writing within
   15 working days.

   If you believe your circumstances to be urgent we recommend that you speak to an Adviser in
   Student Services or ‘The Link’ in the Students’ Union, prior to applying.

How are payments made?
Most awards are paid as a grant direct into your bank account. If the University does not have
your bank account details then you may be sent a cheque to the address you have registered
with the University.

How are decisions made?
Your ‘Grant for Living Cost’ application will be assessed by the Student Funding Team; the
outcome will then be presented to the Student Support Funding Advisory Group who will agree
the level of award. Special Request applications are also considered by the Advisory Group. To
ensure equitable decision making applications are presented to the group without names or
identifying information.

Data Protection
The personal information which you give us, on this form will be used to process your
application. It may also be used for statistical analysis.

Your application will be dealt with in line with the Student Services Department’s Confidentiality

The information will not be passed to any third party outside of the unit without your consent,
except when we are required to do so by law.

Any enquiries about the way this information is used should be addressed to The Student
Funding Officer, who can be contacted through an appointment at the information desk in the
Student Centre.

Finance Adviser Contact Details: You can contact a Finance Adviser in Student Services by
telephoning 01642 342277, or e-mail , Or you can make an
appointment at the Student Centre – Information Desk, Level One.

Alternatively you can see an Adviser in ‘The Link’ by telephoning 01642 342247 or call into ‘The
Link’, situated in the Students’ Union building.

Student Funding Team Contact Details: or telephone 01642 342286

 Office Use Only

 Date received                             Checked by                       Form no

 Course code                                HESA ID



Title e.g. Mr, Mrs, Ms                   Age in years on the 31st July 2010

Enrolment Number

when attending


Do you live at this address all year? (if you normally spend the University vacations elsewhere e.g.
with parents or working away you should tick no).

Yes           No

Email address

Contact telephone number – if this is a mobile number
we may text you.


Name of course, please include title e.g. Degree, HND

Year of course e.g 1st, 2nd, 3rd.            Is this your final year? Yes             No

In what month/ year did you begin your course? e.g Sept 2008

Is this a repeat year of study? Yes             No

Have you completed a Honours Degree before? Yes                   No

If yes please provide the name of the Degree

Do you have a disability, long term medical condition of specific learning difficulty such as Dyslexia?

                      Yes             No

Do you receive a disability related benefit for yourself such as Disability Living Allowance or
Incapacity Benefit or Employment Support Allowance?

                      Yes             No

Does someone in your household, such as a dependant child or partner receive a disability related
benefit such as Disability Living Allowance, Incapacity Benefit or Employment Support Allowance?

                      Yes             No

If yes please state their name & benefit


Please tick one of the boxes
                                  Do you live alone?
                   With children but no other adult?
                        With a parent or guardian?
                                With housemates?
               With a spouse or cohabiting partner?
                  With spouse/ partner & children ?
Give the following details about those who live with you and with whom you have a
relationship with other than housemate. i.e. partner, parents, children. It is very important that
you give this information.

  Name                                Relationship to         Age (please provide date of
                                      you                     birth for any dependant


How will you pay your Tuition Fees? Please tick one of the boxes

Tuition Fee Grant                    Paid by NHS

Tuition Fee Loan                     Parent/ Spouse or partner paying

Pay them yourself                    Other, please state

Are you eligible for a Student/ Maintenance Loan? Yes               No

If you only applied for the non means tested loan (this means that you did not provide any financial
details with your application) please provide an explanation below as to why. NHS students do not
need to complete this box.

Do you receive an NHS Bursary?      Yes               No

   Are you getting a Teesside University Bursary?

            Yes           No           If yes how much are you getting a year?

   If your household income is £25,000 or below you could receive a bursary of £500, £1025 or
   £1300. For more information contact Helen Severs, Student Funding Officer on 01642 342047.

If you are postgraduate student (i.e. doing an MA, MSc, MPhil or PHD) have you taken out a
Professional and Career Development Loan?

      Yes           If Yes please provide evidence.        No      If No please complete box below

If NO please give detail in the box of the funding you have secured to pay your fees and to meet your
living costs. Please attach evidence. Please note that when assessing you for an award we have to
assume that you have secured a basic level of funding.


      Do you have any earnings?                                   Yes                              No

      If YES, how much do you earn on average per week?

     If you have a spouse/ cohabiting partner does s/he have any earnings?                                                                             Yes                             No

     If YES, how much does s/he earn on average per week?

     If you have a spouse/ cohabiting partner, is s/he also a full time student?                                                                          Yes                          No

     If YES where is your partner studying

  Do you, or any partner with whom you live get any of the following benefits?

       Benefit                                                                              Yes                        No              Weekly amount
       Housing Benefit/ Local Housing
       Income Support
       Job Seekers Allowance
       Incapacity Benefit
       Disability Living Allowance
       Carers Allowance
       Child Tax Credits
       Working Tax Credits
       Employment Support Allowance
       Other benefit: Please state


Do you, or any partner with whom you live have any other income?

       Income                                                                                    Yes                   No              Weekly amount
       Child support arranged through CSA/
       Informal child support
                                                                                                 Yes                   No              Annual amount
       Regional grant e.g. Welsh Assembly
       Social Work Bursary
       Excellence Scholarship
       Subject Scholarship
       Care Leavers Bursary
       Contribution from spouse , partner or
       Elite Athlete Bursary
       Other: Please state


How many bank accounts do you have?
Please give the bank/ building society name of each account, including any joint accounts. You will
need to provide 3 months recent bank statements for each account. If you do not have 3 months
statements you can still complete this form but will be asked for statements later. If your statements
show you get regular payments which are not declared elsewhere on the form you may be asked for
more information.
  Name of bank/ building            Name of account holder               Account type e.g. current,
  society                                                                savings etc


On average how many return journeys a week do you make to the place where you study?

Do you walk/cycle to University? Yes             No

Do you use public transport ? Yes             No

If YES, what is the cost daily          or weekly
If you use a car/motorbike, how many miles is it from your home to the place where you study ?

Office use only: Mileage checked on          Mileage
RAC/ AA website

                                  Yes                  No                    Weekly amount
      Do you pay rent?                                                       £
      Do you pay a                                                           £
      Do you pay board? *                                                    £
      Does your rent/ board
      include energy bills?

            * Board is a payment to someone such as a parent for renting a room

           CHILDREN – Complete if you use registered childcare
Have you received help from a debt advice service, e.g a Citizens Advice Bureau, to make reduced
payments to creditors?

YES           NO

If YES please provide evidence of this e.g. a confirmation letter from the service of agreed payments.

 CHILDREN – Complete if you use registered childcare

1. What is your childcare provider Registration Number? If you use more than one provider please
   provide all numbers.

2. Are you getting a childcare grant from a Local Authority/Student Finance England or the NHS
Yes                No

Please read the instructions below so you know what evidence to provide;

 If you are a lone parent or have a spouse/ cohabiting or civil partner who does not have an income
 and you are getting a childcare grant or the childcare element of working tax credits you do not need
 your provider to complete page 10. This is because we will use your childcare grant to work out your
 childcare costs.

 If you have a partner with an income then your childcare grant may be reduced by his/her income.
 Therefore you need to ask your provider to complete page 10.

 If your childcare cost are greater than the following weekly amounts please let us know by getting
 your childcare provider to complete page 10.

 NHS Students                                   None NHS students
 £145 per week for one child                    £175 per week for one child
 £220 per week for two or more children         £300 per week for more than one child


What is your registration number?

Please provide your details below

Your Name

Address where childcare is provided

Contact phone number

Email address

How much does the student pay towards childcare at the following times? The box below
must be completed with the weekly amount and number of weeks.

Weekly during students term time £                     No of weeks out of 52 =
Weekly during student placements (if different         No of weeks out of 52 =
from term time) £
Weekly during child’s school holidays (if different    No of weeks out of 52 =
from term time) £

Please give the names of the student’s children you care for.

Please give the name of the student you provide
childcare for.

Please sign and date the declaration below
I confirm that I provide the childcare at the cost detailed above. I have read the
information below.
Signed                                         Dated

Information for child care provider: Please note that awards are made to the
student and not the child care provider. It is the students responsibility to pay you.


    I hereby confirm that the contents of this application are true and correct. I agree that
    if I get a payment any outstanding Emergency Loan Debt to the Access to Learning
    Fund may be deducted and I will get the balance.

    I agree that if anything in this application is intentionally misleading;
                    The university may take disciplinary and possibly legal action against
                    I will have to repay any money I have received.

    I agree that if my circumstances change during the academic year I will inform the
    Student Funding Team in writing. I understand that the team will reassess my
    application and that I might be expected to repay money if I have received too much.

    I understand that it is my responsibility to keep the University Finance Department up
    to date with my bank account details.

    The Student Funding Team is occasionally asked by the University Finance Department
    to confirm whether a Student has made an application to the Fund. The team would only
    confirm if an application has been made & will not disclose any further details of the
    request or the outcome.
    If you would prefer the team to withhold confirmation that you have made an application
    please tick this box.

    I also confirm that to the best of my knowledge, I fulfil the following criteria (you
    must tick a relevant box).
               I am a UK national
               I am an EU national
               There are no restrictions on my stay & I am settled within the UK (i.e. I have
               the right of abode in the UK or have Indefinite Leave to Enter/ Remain in the
               UK (ILE/R)
               I have been recognised by the UK government as a refugee & have full
               refugee status/ ILE/R in the UK
               I have Exceptional Leave to Enter/Remain in the UK/ Humanitarian
               Protection/Discretionary Leave (ELE/R/HP/DL)
               I am an EEA or Swiss migrant worker or the spouse of an EEA or Swiss
               migrant worker        if you are please state whether you intend to continue
               working while studying.
               I am the child or an EEA or Swiss migrant worker.
    You must also meet the requirement below.
    PLUS I have been ‘Ordinarily Resident in the UK & Islands for 3 years immediately
    before the start of my course

         Signed                                    Date

Have you attached supporting evidence? The checklist below should help you identify
what you need to give us. Please provide photocopies. Please tick each box to indicate
what you have provided. There is also a ‘not applicable’ (N/A) box.
   Funding Assessment letter, if you are getting any Maintenance Loan or grants you
   need to provide this. It shows the amount you have been assessed for.

                                              Provided             N/A
   Student Loan Payment Schedule letter, If you have taken out a Maintenance Loan
   you must provide this. It shows the payment instalments you will get.

                                              Provided              N/A

   Evidence of Tax Credits – If you or your spouse/ cohabiting partner are getting Child
   or Working Tax Credits your need to provide all pages of your most recent Inland
   Revenue assessment letter.
                                              Provided             N/A
   Benefits – If you or your spouse/ cohabiting partner are getting any benefits you need
   to provide evidence. Please note we do not accept payments on bank statements as
                                              Provided               N/A
   NHS Bursary – If you are getting an NHS bursary you need to provide the NHS
   Grants letter showing the grants you are getting.
                                             Provided              N/A

   Evidence of partners earnings e.g. 3 recent payslips, or if self employed tax return
   or recent accounts.
                                           Provided                  N/A
   Evidence of housing costs e.g. mortgage schedule, rent book, tenancy agreement
   or letter from person paying board to.
                                             Provided              N/A
   Evidence of childcare – To have childcare costs include in the assessment you must
   get page 9 of this form completed by your childcare provider.
                                             Provided             N/A

   3 months most recent bank statements – Summary sheets are not sufficient
   Council Tax If you pay Council Tax you need to attach a copy of the bill.
                                           Provided               N/A

   Other – Please make sure you provide evidence of all income you and any spouse/
   cohabiting partner receives.

BANK INFORMATION – for payment by BACS
  Have you previously completed a form to
  establish a direct payment to your Bank
  Account from the University (Not including a University Bursary)?
              YES        NO
         If YES, you do not have to complete this part of the form










  BANK SORT CODE                           ACCOUNT NUMBER

  Please arrange for all future payments to be made by BACS into the
  Bank Account as shown above

  Name                                     Signature
                 IN BLOCK CAPITALS


  BANK DATA CHECKED BY                                       DATE

                                                                                        Student Services Copy


Date received:

Student name (please print):

Student signature:

Staff name (please print):

Staff signature:


                                                                                                     Student’s Copy


Date received:

Student name (please print):

Student signature:

Staff name (please print):

Staff signature:


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