Student Hardship Application Form

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Date Stamp (Office use)

Student Hardship Application Form

Please read the notes and checklist Prior to comPleting this form.

help is available with filling out the application form from student support. if you require help please contact [email protected] or 01970 621761 to arrange a meeting.

When returning the form please ensure you have all relevant documents. You will be required to meet a member of the finance team who will check the form to ensure it is filled in correctly.

incomplete application forms cannot be accepted.

for office use onlY

fcf aPPlication checklist Yes no

1 Tenancy agreement (not required for halls) 2 Student Loan paperwork (Undergraduates) 3 Proof of funding / CDL for Postgraduates 4 3 months bank statements – all accounts

5 Transaction £100 cr/dr detailed on bank statement 6 Proof of any outstanding bills

7 Proof of overdraft limit (minislip / statement) 8 Income & Expenditure complete

9 Supporting Statement 10 Form Completed & Signed

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the Process

Completed application forms should be submitted in person with ALL of the supporting evidence (please see checklist overleaf).

Postal applications can be accepted for students not currently residing in Aberystwyth.

contact details

Completed forms should be returned to:

Student Support,

Reception, ground Floor, Student Welcome Centre, Penglais Campus, Aberystwyth SY23 3FB

MOnDAY to FRIDAY, 10.00am – 3.00pm

Service times change during vacation periods, please check with us.

Email: [email protected] Telephone: 01970 621 761

Your form will be assessed (providing you have attached all of the required information) and a decision made within 15 working days. We aim to process applications quicker

than this and this is aided by the prompt provision of all relevant documentation.

grants will only be awarded where a student has insufficient funds available to cover remaining necessary expenditure.

All awards are discretionary.

hoW to aPPeal

If you are not satisfied with the decision, please contact Student Support

for more information regarding our appeals procedure.

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Part 1 : Your Personal details

First name: Student number:

Surname: Date of Birth:

Term-time address: Home address:

Postcode: Postcode:

Contact phone number:

Aberystwyth E-mail:

Alternative E-mail:

Are you an independent student?

■

YES

■

nO. If ‘YES’, please tick as appropriate:

■

You are 25 or over before the start of this academic year;

■

You have been married or entered into a civil partnership before the start of this academic year;

■

You have care of a child / children;

■

You have supported yourself for at least three years before the start of your course;

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Part 2 : course details

Course title:

Department:

Course level:

■

Undergraduate

■

Postgraduate

■

Postgraduate Writing Up Period

■

Full-time

■

Part-time

■

Distance Learning

number of credits: End date:

Year of course (e.g. 1st): Length of course: Years

Is this a repeat year?

■

YES

■

^nO

Is this your final year?

■

YES

■

^nO

Part 3 : Your dePendants

Are any adults or children financially dependant on you?

■

YES

■

nO If ‘YES’, please give details.

If any of these dependants do not live with you permanently, please indicate how often they stay with you.

Name Date of Birth relatioNship to you frequeNcy aND

leNgth of visits

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Part 4 : income (Please supply the evidence requested alongside each box you complete.)

a: all students moNthly eviDeNce NeeDeD checK

list

Maintenance Loan Student Finance notification letter and last 3

months bank statements, one showing receipt of loan instalment.

Parental Contribution Annotate on bank statements or provide a letter /

e-mail from family stating total contribution over the academic year.

Maintenance grant / other support grants Student Finance (or other) notification letter

Aberystwyth University Bursary notification letter confirming your bursary

Teacher Training grant notification letter

Professional / Career Development Loan Loan agreement and payment schedule.

Disability / Incapacity Benefits Benefit decision notice

Part-time earnings (Term Time) Annotate payments on bank statements or P45 if work ended.

B: students With Partners and / or dePendants

Partner’s net Earnings Annotate payments on bank statements or P45 if

work ended.

Partner’s Benefits, Pensions, etc. notification letters

Partner’s Maintenance Relevant proof

Parents Learning Allowance

Student Finance breakdown or bursary notification.

Dependants grant

Child Care grant

Tax Credits Award notification from HMRC.

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Part 5 : eXPenditure (Please supply the evidence requested alongside each box you complete.)

all students moNthly eviDeNce NeeDeD checK

list Food / Household / Toiletries / Laundry

Documentary evidence not required for these categories as standard figures are used for assessment.

Utillity Bills: gas / Electricity / Water

Telephone

Clothes and Shoes

Leisure

Rent / Mortgage Tenancy or mortgage agreement. Should also be

annotated on your 3 months bank statements.

Insurance: Building, Life, Contents notification document.

Council Tax Current Council Tax bill.

Daily Travel to University

Travel to and from home for vacations

OTHER ExPEnDITURE

Internet

Car Costs

Health costs, e.g. eye care, dental care,

diagnostic tests e.g. invoice for diagnostic tests

Tuition Fees

(if not paid by grant, loan, or parent)

Other course costs, e.g. field trips, materials e.g. Confirmation from your department that the trip is compulsory, the dates, the location and the cost to you. Receipts for items over £50.

CHILD CARE

Registered Letter from childcare provider confirming the cost.

Unregistered

Maintenance Payments Relevant proof, e.g. CSA letter or bank statements.

total

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Part 7 : disaBilitY / dYsleXia / sPecial medical needs

Do you have a disability or chronic medical condition?

■

YES

■

^nO

Have you applied for Disabled Students’ Allowance?

■

YES

■

^nO

(If ‘YES’, please provide a copy of your disability support letter.)

Are you happy for this information to be shared with the University’s Accessibility Services team?

■

YES

■

^nO

Part 9 : Bank / Building societY details

Any award will be paid into the first account shown below. You must supply copies of your last three bank statements (and your savings books) and a printout showing your present account balance for each of your accounts. please describe all transactions over £100 that appear on the statements.

Account 1 2 3 4

Bank / BS name Savings Accounts /

ISAs Sort code

Account no

Part 6 : deBts (Please list your debts below, including those to the university and store/debit cards.)

creditor – person / company owed amount Nature of debt, e.g. rent, credit / store cards

Part 8 : Postgraduate students

Have you made adequate provisions to cover tuition fees and basic living costs prior to starting your course?

■

^YES

(We will require evidence to support this.)

ü

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Part 10 : suPPorting statement

Please state why you are in financial difficulty and require additional support. Include any other information not covered elsewhere on the form. Continue on a separate sheet if necessary.

Please explain what steps you have taken to address your financial difficulties, e.g. review your overdraft status, part-time work:

postgraduate students

You are expected to have made provisions to cover your tuition fees and basic living costs before applying to this fund.

If you have not taken out a Professional Career Development Loan please explain your reasons:

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Part 11 : universitY deBts

if you owe money to the university (other than tuition fees for full-time students), and you agree that it can be deducted from your hardship fund award, please sign here:

Part 12 : Private sector / third PartY deBts

if you owe money to a third party and you agree that it can be deducated from your hardship fund award please sign below and provide the relevant bank details:

Part 13 : declaration

• I certify that all the information given on this form is correct and complete and I understand that giving false information may constitute fraud and the university may pursue such matters through criminal prosecution.

• I understand that giving false information or failing to disclose all relevant information may render me liable to disciplinary action by the university and i may be required to repay any grants obtained by me as a result.

• I give permission for enquiries to be made of the relevant authorities to substantiate the information provided.

• I undertake to notify you of any changes in my circumstances immediately, and in the event that I withdraw I undertake to repay any award granted.

Signature: Date: