Financial Support Application

Part A - Student Personal Information.

First name*

Surname:*

Date of birth:*

Age as of 31/08/2021:*

Nationality*

Email address*

Have you been resident in the UK/EEA for the last 3 years?

Yes
No

Are you an Asylum Seeker?

Yes
No

Home address*

Postcode*

Telephone number*

Mobile number*

Please indicate who you live with

Do you have any dependant children?

Yes
No

If yes how many dependent children?

How old are the dependent children?

Do you have an Education Health Plan?

Yes (please attach)
No

Education Health Plan

Drop files here or

Max. file size: 64 MB.

Part B - Course Information

What is the title of your course?*

What is your intended campus of study?*

Ashington Campus
Berwick Campus
Kirkley Hall Campus
Kirkley Halls of Residence

If other, please state

Days of Attendance at college:

Monday
Tuesday
Wednesday
Thursday
Friday

Previous Student No. (if applicable)

Part C - Other Information

Transport arrangements - to be completed by all students.

Please indicate how you will travel to College:

Public Transport
Private transport
Local Authority Taxi
Coopers Bus
Other

If Other, please state:

If using Public Transport please indicate which transport operator you need to use to attend college:

Stagecoach Buses
Go North East Buses
Arriva
Require Combination
Metro
Other

If Other, please state:

Do you currently have a Coopers Bus Pass?

Yes
No

Please indicate the weekly cost of travel

Are you living in Northumberland?

Yes
No

16-18 and Y12 or Y13 - Have you applied to Northumberland County Council for the 16-18 travel scheme? (see eligibility criteria on webpage)

Yes
No

Do you have evidence of successful application?

Yes
No

(If you have been rejected for free travel with Northumberland County Council or you live outside of Northumberland, please apply directly to Northumberland College)

16-18, 19+ SEN transport: Apply directly to Northumberland County Council

This section is only to be completed by students aged 16-18:

Have you ever been in care/or are a care leaver? If yes please attach a letter from your Social Worker/Local Authority

Yes
No

Social Worker/Local Authority Letter

Drop files here or

Max. file size: 64 MB.

As a young person are you claiming Income Support or Universal Credit in your own right?

Yes
No

As a young person are you claiming Employment and Support Allowance together with either Personal Independence Payment of DLA?

Yes
No

Do you give permission for your award and payments to be discussed with parent(s)/guardian(s)?

Yes
No

Childcare (20+)

Name and age of child 1

Please make sure you provide the correct name.

Name and age of child 2

Please make sure you provide the correct name.

Name of childcare provider

Please note, as part of the assessment validation process, the college will make contact with the childcare provider cited above to confirm arrangements

Address of childcare provider

Email

UKPRN

Provider Bank Details

Hourly Rate Charged

Do you use government funded hours to support childcare whilst you attend college and/or work?

Yes
No

Part D - Student’s Bank Information.

Student must have their own account.

Full name of Account Holder:*

Name of Bank:*

Branch*

Sort code (6 digits):*

Account number (8 digits)*

Please enclose evidence of bank account such as letter from bank/statement.

Drop files here or

Max. file size: 64 MB.

Part E - Income Details

If 16-18 to be filled in by parent(s)/guardian(s) if 19+ to be filled in by student.

Please indicate if claiming any of the following benefits (check all which apply):

Annual Salary
Pension Credits (minimum guarantee credit)
Universal Credit
Employment & Support Allowance (income related)
Child Tax Credit
Income Support
Job Seekers Allowance (income based)
Working Tax Credit
Other

Please remember if you are applying for Free School Meals, evidence included must include one of the following: Income Support, Income-based Jobseeker’s Allowance, Income-related Employment and Support Allowance, Support under Part VI of the Immigration and Asylum Act 1999, The guaranteed element of Pension Credit, Child Tax Credit (pro vided you’re not also entitled to Working Tax Credit and have an annual gross income of no more than £16,190), Working Tax Credit run-on - paid for 4 weeks after you stop qualifying for Working Tax Credit & Universal Credit - if you apply on or after 1 April 2018 your household income must be less than £7,400 a year (after tax and not including any benefits you get).

Do you work?

Yes
No

Please outline Gross Annual Income £:

Adult 1 Adult 2

Please upload proof of benefit or income such as a photocopy of a recent letter from benefit authority/bank statement/tax credit award notice 2021-2022/p60.

Drop files here or

Max. file size: 64 MB.

Part F - Signature

If aged 16-18 both the student and parent/guardian should complete this section.

I understand that payments are subject to me achieving agreed standards of behaviour, commitment and attendance each month. I confirm that I agree to the summary conditions which will be outlined fully in my award notification, and the Guidance for Students. I confirm that the information given in this form is correct and complete to the best of my knowledge. I understand that the College has the right to make an independent check of any evidence produced and such action as is deemed appropriate in the event of any information I have given proven to be incorrect or false.

By pressing submit, I am confirming I have read, understood and agree to all points referenced in this form including part F.

Yes
No

Please check that you have answered each section fully. Incomplete forms cannot be processed.

I have read and understood the Financial Support Application & Privacy Notice

Financial Support Information & Privacy Notice:

Part A - Student Personal Information.

Part B - Course Information

Part C - Other Information Transport arrangements - to be completed by all students.

Transport arrangements - to be completed by all students.

16-18, 19+ SEN transport: Apply directly to Northumberland County Council

This section is only to be completed by students aged 16-18:

Childcare (20+)

Part D - Student’s Bank Information. Student must have their own account.

Student must have their own account.

Part E - Income Details If 16-18 to be filled in by parent(s)/guardian(s) if 19+ to be filled in by student.

If 16-18 to be filled in by parent(s)/guardian(s) if 19+ to be filled in by student.

Please check that you have answered each section fully. Incomplete forms cannot be processed.

Part C - Other Information

Transport arrangements - to be completed by all students.

Part D - Student’s Bank Information.

Student must have their own account.

Part E - Income Details

If 16-18 to be filled in by parent(s)/guardian(s) if 19+ to be filled in by student.