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Residential and Discretionary Learner Support Fund Application Form 2020/21
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Residential and Discretionary Learner Support Fund Application Form 20...
Residential and Discretionary Learner Support Fund Application Form 2020/21
Please complete this application form to request financial assistance.
If you require any assistance whilst completing this form please contact our Student Finance Team by emailing
studentfinance@reaseheath.ac.uk
.
Step 1 of 5
20%
Student Details
Name
*
Prefix
Mr
Mrs
Miss
Ms
Dr
Prof.
Rev.
First
Last
Date of birth
*
DD
MM
YYYY
Age (as at 31/08/2020)
*
Address
*
Address Line 1
Address Line 2
City
County
Post code
Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Have you been a resident in the UK/EU for the past 3 years
*
Please select
Yes
No
Contact telephone number
*
Preferred email address for correspondence
*
Enter Email
Confirm Email
Course subject area
*
Please select
Adventure Sports
Agricultural Engineering
Agriculture
Animal Management
Aquatic Ecosystems & Fisheries Management
Bakery, Patisserie & Confectionery
Business & Events Management
Conservation & Wildlife Management
Construction
Entry & Foundation Learning
Equine
Floristry
Food Technology
Forestry & Arboriculture
Game & Wildlife Management
Horticulture
Motor Vehicle
Personal Training
Public Services
Sport
Veterinary Nursing
Other/unknown
Other/unknown
*
Please type the subject area here
Level of course
*
If you are studying a Level 3 course, are you intending to apply/have already applied for an Advanced Learner Loan
*
Yes
No
Guaranteed Group
The college will support guaranteed group learners to the value of £1,200 in cash and in kind.
Are you in receipt of Disability Living Allowance and Employment Support Allowance in your own name?
*
Yes
No
You will need to supply a copy of the relevant documentation to show you fall into this category.
Are you in receipt of a Personal Independence Payment and Employment Support Allowance in your own name?
*
Yes
No
You will need to supply a copy of the relevant documentation to show you fall into this category.
Are you in care/or a care leaver and are aged between 16-18?
*
Yes
No
You will need to supply a copy of the relevant documentation to show you fall into this category.
Do you receive income support in your own name and are aged between 16-18?
*
Yes
No
You will need to supply a copy of the relevant documentation to show you fall into this category.
Do you receive a Universal Credit payment in your own name and are aged between 16-18?
*
Yes
No
You will need to supply a copy of the relevant documentation to show you fall into this category.
Request for Assistance
Please select all of the following that you wish to receive help with. The college will assess the level of contribution based on your household income.
Travel to work experience/placement
Car travel from home to Reaseheath
Public transport costs
Free college meals (conditions apply)
Essential basic equipment
Help with Childcare costs (age 20+)
Tuition fees
Residential costs
College bus pass
Only students aged 19+ studying a level 1 or 2 course can request help with tuition fees.
Agriculture students
Stock duties
Adventure Sports/Public Services students
Residential trip
Food/Bakery students
Laundry
Household Income
Please indicate below any income received in your household, copies of the relevant documents will be required. If not applicable, please leave the boxes blank.
All applications for financial assistance are subject to means-testing.
Salary
Proof - P60 (from 19/20)
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Self employment income
Proof - accountant letter
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Child and working tax credit (not including childcare or disabled elements)
Proof - award notification in full
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Pension (state, private or credits)
Proof - P60 (from 19/20)
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Job seekers allowance
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Disability living allowance or personal independence payment
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Universal credit payment
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Employment and support allowance
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Income support
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Carers allowance
Proof - award notification
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
Other
Name
Mother
Father
Guardian/Step-parent
Husband/Wife or Partner
Student
How will you provide us with any proof as required above?
Please select
I will post documents to Student Finance
I will email copies to studentfinance@reaseheath.ac.uk
Declaration
To be signed by the student
*
I declare that the information given in this application form is, to the best of my knowledge, information and belief, true in all aspects.I understand that if I knowingly make a false statement or provide false information, I may render myself liable for prosecution.
I authorise Reaseheath College or a representative to check any information I have given in this application.
I will inform Reaseheath College immediately if I withdraw from or stop attending my course and I understand that I may have to repay part or all of the residential/lodgings and associated costs if I withdraw from my course.
I undertake to repay any sums overpaid to me if required to do so.
I am applying for support funds as my main source of funding for my costs. I will tell Reaseheath College if I receive help with these costs from other sources.
I also undertake to declare any funding I receive if I apply for help from other sources.
I agree that the information provided in this form may be used by the Department for education and skills and its agents in connection with management, evaluation and auditing purposes.
I agree with the above
Name of student
*
To be signed by the parent/guardian
*
This information I have given on this form is complete and accurate to the best of my knowledge and belief.
I will inform you immediately of any change in my circumstances which might affect this application for support.
I agree to supply further information you may ask for. I understand that if I give false information, or fail to give complete information, I may be prosecuted.
I agree to with the above
Date
*
Phone
This field is for validation purposes and should be left unchanged.
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