STUDENT FINANCE Applcation Form

7/30/2019 STUDENT FINANCE Applcation Form

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Application forStudent Finance

2010/11

SFE/PN1F/1011PN1

www.direct.gov.uk/studentfinanceThis form is also available at


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finance available

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You can apply for the following student finance by completing this form:

Maintenance Grant Adult Dependants Grant Disabled Students Allowances Special Support Grant Childcare Grant Bursaries and Scholarships

Maintenance Loan Parents Learning Allowance Travel Grant

Tuition Fee Loan

You can find more detailed information on what is available and what you might be entitled to in'A guide to financial support for higher education students 2010/11' or by using our Student FinanceCalculator. Both are available from www.direct.gov.uk/studentfinance .

You can apply in 5 easy steps(Depending on your circumstances you may not need to complete all of the steps)

We have provided guidance notes to help with any difficult questions so please refer to these eachtime you see this icon.

You will have to send evidence with your application whenever you see this icon.Details about the evidence you need to send can be found in the guidance notes.

For all students Complete sections 2-6.

Dont forget if you are applying for a loan you need to tell us how much you want bycompleting the Loan Request section on page 14.

You do not need to complete section 6 if you are only applying for a Tuition Fee Loan.

For students who want student finance based on household income

Complete sections 7 and 8. If you think you qualify for the Special Support Grant, please tick this box.

Detailed information about who can qualify for the Special Support Grant andwhat evidence needs to be provided can be found in the notes.

If you only want to apply for a Tuition Fee Loan or a reduced rate of Maintenance Loan you cango directly to Step 5.

For students who want student finance based on household income

Complete section 10. Depending on your answers in section 10 you may need to ask your parent(s) or

partner to provide details about their income in section 11 so we can work out whatyour full entitlement to student finance will be.

For all students

Make sure that you read and sign the Student Declaration on pages 21/22.If you asked someone to complete section 11, make sure that they have signedtheir declarations on page 29.

If you are a single independent student go directly to Step 5.

Tick

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For students who have dependants

Complete section 9.

You should complete this section if you have any children or adult dependants and want toapply for financial help in relation to them.

Step

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Step

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Step

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finance available

Childcare Grant

If you want to apply for the Childcare Grant you

need to complete this form then complete a

Childcare Grant application form.

Please send me a Childcare Grant application

form:

Disabled Students Allowances (DSAs)

If you want to apply for DSAs you need to

complete this form then complete a Disabled

Students Allowances application form.

Please send me a DSA form:

Other student finance available

Tick

Tick

Childcare Grant and DSA application forms can also be downloaded from www.direct.gov.uk/studentfinance

or requested by calling us on 0845 300 50 90.

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Please remember to pay the correct postage.

What if I have further questions?

If you have further questions you can:

visit our website at www.direct.gov.uk/studentfinance

refer to 'A guide to financial support for higher education students 2010/11'

call us on 0845 300 50 90

When do I need to send you my form?

If you are applying for student finance which does not require any financial information to beprovided, you must return your form to us by 23 April 2010 in order to ensure you receive yourfirst payment at the start of term.

If you are applying for student finance which does require financial information to be provided,you must return your form to us by 25 June 2010 in order to ensure you receive your firstpayment at the start of term.

If you miss this deadline, your application will be processed as soon as possible, but your first

payment may not be available at the start of term.This form should be returned within 9 months of the start of your academic year, otherwise youmay lose your full entitlement to student finance.

Where do I send my form?

Return this form to us at Student Finance England, PO Box 210, Darlington, DL1 9HJ.


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(3) Send your original birth or adoption certificate and a completed Birth/AdoptionCertificate form.

Title

Forename(s)

Surname

Sex

Date of birth

Place of birth (the name of the townor village)

Nationality

Do you hold a UK passport?

Passport number

Forename(s)

Surname

Date of issue

Date of expiry

(2) Send your non-UK passport.

personal details

Mr Mrs Miss Ms

Male Female

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Yes No

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You must provide us with evidence of your identity. You can do so in one of thefollowing ways:

Please complete these questions with the details as

exactly stated on your birth certificate or passport.

/ /

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(1) Provide the following details from your UK Passport, which must be currently valid andnot expired (this is the easiest way for you to verify your identity and means you donot need to send us your Passport.

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Please tick one box.

Home address

Postcode:

Home phone number:

Term-time address

Postcode:

Date on which you will move to this address:

/ /

Mobile phone number:

Email address:

Please give your current home address. If you know it, please also give your term-timecorrespondence address.

Single

Living with a partner

Married/civil partnershipPlease give the date of marriage/civil partnership

Separated

Divorced/dissolved civil partnership

Widowed/surviving civil partner

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personal details

Have you ever had any other loans fromthe Student Loans Company (SLC)?

If 'Yes', are you behind with therepayments?

Did you receive a loan from the SLCwhen you were under 18?

If 'Yes', have you signed creditagreements for all of them?

Yes No

Yes No

Yes No

Yes No

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If No go to e

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If No go to e


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Are you a UK national?

Are you an EU national?

Are you the child of a Swiss national?

Do you have 'settled status' in the

UK?

If 'Yes', give the date you received this

status.

Have you or your:

husband, wife, civil partner; or parent(s), step-parent; or parent's or step-parent's husband,

wife or civil partner

been granted 'refugee status' by theUK Government?

If 'Yes', and if applicable, please givethe following:

Home Office reference number

Date this status is due to expire

residence

Yes No

Yes No

Yes No

Yes No

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If Yes go to b2

If No go to a5

go to b2

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Yes No

Yes No

If 'Yes' go to b1

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Yes No

Are you or your:

husband, wife, civil partner; or parent(s), step-parent or child, son or daughter-in-law, child's civil partner; or parent's or step-parent's husband, wife or civil partner

a European Economic Area (EEA) national or Swiss national who isworking, has worked or is looking for work in the UK?

If Yes, please give details.

If you are currently working, are you going to continue workingduring your studies?

If 'Yes', please give details.

go to b2

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If No go to a6

If No go to a7

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Have you or your:

husband, wife, civil partner; or

parent(s), step-parent; or

parent's or step-parent's husband,

wife or civil partnerbeen given 'leave to enter or remain'in the UK as a result of a failed asylumapplication?

If 'Yes', and if applicable, please givethe following:

Home Office reference number

Date this status is due to expire

In the three years prior to the start ofthe first academic year of your course,did you live outside the UK and Islandsat any time?

Give details of your residence for thethree years before the start of the firstacademic year of your course.

If you require further space to provideyour answer, please give the detailsrequested above on the AdditionalNotes section at the back of this form.

residence

Yes No

Yes No If No go to b2

Full address

From:

To:

Why were you there?

Full address

Why were you there?

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From:

To:

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If No go to b3

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go to b2


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At any time since 1 September 2007

has:

either of your parents, step-parents,

guardians; or

your husband, wife, civil

partner; or your parent's or step-parent's

husband, wife or civil partner

lived or worked outside the UK and

Islands or, in the case of an EU, EEA or

Swiss national, outside the EEA or

Switzerland?

If 'Yes' please give details.

residence

Yes No

Full address

From:

To:

Why were they there?

Full address


Full address


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From:

To:

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From:

To:

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University/college name and address

UCAS personal identification number

UCAS university/college code

UCAS campus code (if applicable)

Course name

If you are following a combined studiesor modular course, please list allsubjects being studied

UCAS course code

Qualification you expect to gain(e.g. BSc Physics)

Course start date (month and year)

Course end date (month and year)

Course length (years)

Year of course

Full tuition fee amount for academicyear 2010/11

If the course is franchised to anotheruniversity/college, give the address ofthe other university/college.

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In this section, please give details of your first choice university/college and course.

Foundation year Third year

First year Fourth year

Second year

Other (give details)

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Postcode:

Postcode:

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about your course and youruniversity/college


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Full-time undergraduate

Full-time postgraduate Initial TeacherTraining (ITT)

Full-time foundation degree

Full-time distance learning

Full-time involving a placement(sandwich course)

Have you been awarded a state-fundedplace on a dance and drama course ata privately-funded institution?

Where will you live during theacademic year 2010/11?

Term 1

Living with parent(s)

Elsewhere or own home

Term 2Living with parent(s)


Term 3

Living with parent(s)


Yes Noe

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Do you have a disability which preventsyou from attending your university/college in person?

Yes No


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Where will you spend most of yourtime studying in the academic year2010/11?

Where will your placement be?

If your placement is abroad, have youbeen accepted onto the ERASMUSexchange scheme?

Placement name and address if known:

Is the placement:

If you ticked 'unpaid' please tick which

type:


Term 1

University or college

Study abroad

Placement in the UK or abroad

Term 2


Study abroad


Term 3


Study abroad


If you have ticked University or college and/orStudy abroad for all 3 terms go to Section 5

Abroad UK Dont know

paid

unpaid

a hospital, Public Health Service Laboratory

or with a Primary Care Trust;a Health Authority, Strategic HealthAuthority, Local Health Board, Special HealthAuthority, Health Board, Special Health Boardor a Health and Social Services Board;

a Local Authority carrying out its dutiesrelating to health, welfare or caring forchildren and young people, a voluntaryorganisation providing facilities or carryingout similar activities;

the prison or probation sector or after-careservices;

unpaid research in a UK or overseasinstitution; or

an unpaid placement that is not listed above.

Postcode:

Yes No


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Have you started an undergraduatecourse of higher education in any

country since leaving school? Tick Yeseven if you did not complete thecourse.

Did you achieve a qualification?

Was the level of the qualification(s)achieved equal to or higher than thelevel of course you are now applyingfor?

previous study and other information

Yes No

Yes No

Yes No

Datestarted

Name ofuniversityor college

Title of course(e.g. BA History)

Town and countryof university orcollege

(MM YYYY)

Date left

(MM YYYY)

Did youachieve aqualification

If you did not achieve a qualification for anycourse listed above, why was this?

Please give course details below. Do not mention any course that you studied part-time whereyou did not achieve a qualification; or any course that was entirely self-funded at a privateuniversity or college where you did not achieve a qualification.

Yes No

Yes No

Yes No

Yes No

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Courses of higher education are those of HNC level or above. Where course details are requested,you should not include A Level/AS Level examinations or equivalent.

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If No go to a4

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previous study and other information

Have you applied, or will you be applyingfor any bursary or award, excluding asocial work bursary, for the academic year2010/11 from any of the following:

National Health Service (NHS) Department of Health (DoH)

Scottish Government Health DirectorateBursary (Scottish Healthcare Allowance)

If you applied for support, whether or notyou received it, tick 'Yes'.

If Yes, is this bursary or award incomeassessed or non-income assessed?

Yes No

Income assessed

Non-income assessed

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Sort code

Account number

Building society roll number (if applicable)

your UK bank or building society accountdetails

This account must be in your own name and be able to accept direct credits.Please note that missing or incorrect bank or building society details will result in your MaintenanceLoan, bursary (if applicable) or any grant payments being delayed.

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National Insurance Number

loan request section

Tick

If you are applying for a Maintenance Loan, a Tuition Fee Loan or both, please complete this sectionto tell us how much you want to apply for.

Maximum available to you:

If you wish to apply for lessthan the maximum available toyou, please state the amount.

TickMaximum available to you:

If you wish to apply for less thanthe maximum available to you,please state the amount.

Contact 1

Forename(s):

Surname:

Relationship to you:

Address:

Postcode:

Phone number:

Please give the names and addresses of two contacts. The contacts you give should live at different

addresses and will only be contacted if, for example, you move address and do not inform us. Youmust inform your contacts that you are providing us with their details.

Contact 2

Forename(s):

Surname:

Relationship to you:

Address:

Postcode:

Phone number:

Contact details

You can apply for up to a maximum of 3,290 depending on your circumstances. You should findout how much your university or college is charging before you apply for a Tuition Fee Loan.

Amount of Tuition Fee Loan you would liketo apply for:

Amount of Maintenance Loan you wouldlike to apply for:

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dependent and independent students

Will you be 25 or over on the first dayof the academic year?

Have you been married or in a civilpartnership at any time before the firstday of the academic year?

Will you have care of a person underthe age of 18 on the first day of theacademic year?

Please tick the relevant box if any ofthe following apply to you.

Yes No

If Yes you are an independent student, go to Section 8

Yes No

If Yes you are an independent student, go to Section 8

Yes No

If Yes, you may be considered an independent student, goto Section 8

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This section determines whether you are a dependent or an independent student. This is important as itestablishes whose income we need to take into account from your household before we calculate yourentitlement.

Your parents cannot be found or it is notreasonably practicable to get in touch withthem.

You are irreconcilably estranged (have nocontact with) from your parents and this willnot change.

At any point from the age of 16 to the startof your course, you have not been under the

legal care of your parents; and, for threemonths or more, you have been in the custodyor legal care of, or have been givenaccommodation by, a local authority.

Both your parents have died.

You have applied for student finance before,and the parent who was assessed for acontribution has died.

Your parents are living outside the EuropeanUnion and the assessment of their financialcircumstances would place them in jeopardy.

Your parents are living outside the EuropeanUnion and it would not be reasonablypracticable or possible for them to send youmoney.

If you have ticked any of the boxes above, youwill be contacted for evidence and, subject tothis, you may be considered independent.

if you have ticked any of the boxes above,go to Section 8

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dependent and independent studentsHave you supported yourself financiallyfor a total of three years or more priorto the start of the first academic year ofyour course? Yes No

FromDid you work full orpart-time

Name and address ofyour employer or yourbenefit office

(MM YYYY)

To

(MM YYYY)

Amount of salarywages or benefityou have received(state whether itwas weekly, monthlyor yearly)

If you have answered No to all the questions in this section you will be considered adependent student.

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If 'Yes', you may be considered an independent student. Please give details below.

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student financial questions

Please estimate the total taxableunearned income, before deductions,that you expect to receive in academicyear 2010/11.

What is the source of this income?

Will your employer be releasing you toattend your course for the academicyear 2010/11?

If Yes, how much will your employerpay you for time spent attending yourcourse during this period?

During the academic year 2010/11, will

you or your employer pay any moneyinto a pension fund on your behalf?

If Yes, how much during this period?

If you leave any question blank we will not be able to process your application.If a question does not apply to you, please enter 'None' or 'N/A' as the answer.

Yes No

Yes No

Taxable unearned income is any income you receive from the following sources:

Bank or building society gross interest.

Property, lettings or rent.

Dividends or investments.

Trusts or sponsorships.

Any other payment received for attending the course.

Give details of any children who will be wholly or mainly financially dependent on you duringthe academic year 2010/11.

When stating the child's income, include their income from all sources after income tax andsocial security contributions.

Whom willthey live with?

Date ofbirth

Childs full name Relationshipto you

Childs income

(DD MM YYYY) ()

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If No go to d

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Are you a lone parent?

Are you under 25, living with a partnerand applying for Childcare Grant orParents' Learning Allowance?

Give the total estimated income afterincome tax and National Insurancedeductions in the academic year2010/11 for:

How much of this will be Child TaxCredit for the academic year 2010/11?

d

Give an estimate of your husband's,wife's, partner's or other adultdependant's income for the academicyear 2010/11.

Income from earnings after deductions

Adoption Agency payments

Any disability pension or benefit

Child Benefit

Guardian's Allowance

Fostering or Boarding Out payments

Residence Order Allowance

Child Tax Credit

Working Tax Credit

All other income after deductions

If other, what is it?

Yes No If Yes go to d

Yes No If No go to d

go to f

You: Your partner:

You: Your partner:

Husband,wife or partner

Other adultdependant

Only complete this section if you are applying for Parents' Learning Allowance, Adult Dependants'

Grant or Childcare Grant.

section 9 Parents' Learning Allowance, Adult Dependants'Grant and Childcare Grant

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If you are a lone parent and are not claiming Adult Dependants' Grant


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If applying for Adult Dependants'Grant, please indicate who the adultdependant is.

Give details of financial commitmentsyou have before the start of the coursewhich you, your husband, wife orpartner will continue to pay for youduring the academic year.

Answer this question if you are applyingfor Childcare Grant.

Do you, your husband, wife or partnerreceive, or expect to receive, thechildcare element of Working TaxCredit?

Your husband

Your wife

Your partner (if you are 25 or over)

Other adult dependant

Type

Type

Type

Type

e

Yes No

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If 'Yes', you cannot also receive Childcare Grant. But you can choose to receive Childcare Grantinstead of the childcare element of Working Tax Credit if you wish.

section 9 Parents' Learning Allowance, Adult Dependants'Grant and Childcare Grant


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With which parent do you normally live, or have more contact with?

What we mean by 'parent', for the purposes of working out your household income can

change depending on when you started in higher education.

SFE/PN1F/1011

about your family

Single

Living with a partner

Married/civil partnership

Separated

Divorced/dissolved civil partnership

Widowed/surviving civil partner

ee

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If you are a dependent student go to question a.

If you are an independent student with a partner, please read and sign the Student Declarationon pages 21/22 and then pass this form to your partner to complete section 11.

If you are a single independent student, go to the Student Declaration on pages 21/22.

Mother Father Both N/Aor

What is the marital status of this parent? Now please read and sign the Student

Declaration on pages 21/22 and then

pass this form to the person(s) who you

have indicated in 'question a' to

complete section 11.

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Before signing and returning your completedform, you should read the Data ProtectionStatement in the accompanying notes.

This declaration covers all of the studentfinance available to students for academic

year 2010/11.You should read the specific terms andconditions about loans, Childcare Grant andDisabled Students Allowances because theywill affect you if you apply for them at anytime in academic year 2010/11. If you dontapply for these in academic year 2010/11their specific terms and conditions will notaffect you.

Your application for financial support may bedelayed unless you sign and date thisdeclaration.

I confirm that to the best of my knowledgeand belief, the information I have provided istrue and complete. If it is not I understand Imight be refused financial support, orprosecuted and my financial supportwithdrawn.

I agree to give SLC any information theyrequire to process my application and agreeto tell them immediately if my circumstanceschange in any way that might affect my

entitlement to financial support. Iunderstand that if I do not do this, I may notreceive any further payments, and may haveto repay the financial support I have alreadyreceived.

I agree that in the event of receiving anoverpayment of financial support, I amobligated to repay this in full.

I understand that if I have provided detailsof my UK passport, SLC will verify thosedetails with the Identity and Passport Service.

a I have read and understood the booklet'Student loans: A guide to terms andconditions'.

b I acknowledge and agree that any loan(s)made to me by the Secretary of State forBusiness, Innovation and Skills, 'the lender'(which includes any persons exercisingfunctions on behalf of the Secretary of Statepursuant to section 23(4) of the Teachingand Higher Education Act 1998 as amendedfrom time to time or successor legislation,the Act) will be on the terms set out in the

Loan Request Form including these

declarations and in Regulations which aremade under section 22 of the Act asamended from time to time.

c I undertake to repay the lender any loan(s)made to me, together with all and any

interest, penalties and charges which apply.d I agree that any loan(s) made to me as a

consequence of the acceptance of myapplication by the lender is a/are contract(s)between me and the lender which binds mefrom the payment to me of the first loanadvance and that the repayment of any suchloan(s), together with all and any interest,penalties and charges which apply, will bedue by me to the lender as a debt.

e I agree that I shall be obliged to makerepayment of my loan(s), together with all

and any interest, penalties and chargeswhich apply, to such address as shall benotified to me in writing and that anyservices in respect of my loan(s) may beprovided at such address or other address(es)as the lender may from time to timedetermine and that the service of providingthe loan is provided at the lenders principaladdress.

f I agree that any action for repayment and/orin respect of or in connection with my loan(s)and/or all and any interest, penalties andcharges which apply, will be brought before

the ordinary civil courts and shall begoverned by the general rules of civilprocedure.

g I agree that my request for a loan, the loanand the contract between me and the lendershall be governed by the law of the place ofmy home address as stated in this applicationform (or, if my address is outside the UnitedKingdom, English law).

h I irrevocably agree that the courts of the partof the United Kingdom in which my homeaddress stated in this application form is

situated (or the English, Scottish andNorthern Ireland courts where my address isoutside the United Kingdom) shall have non-exclusive jurisdiction to hear any action orproceedings arising out of or in connectionwith the loan and the contract between meand the lender and I irrevocably submit tothe jurisdiction of those courts and waiveany objection to the jurisdiction of thosecourts, provided that this shall not limit thelenders rights to take proceedings againstme in any other court of competentjurisdiction.

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Date:

Your full name (in BLOCK CAPITALS):

Your signature:

/ /X

Your decision about bursary and scholarship datasharing consent will not affect your entitlementto any other financial support available.

If you started your course in academic year2006/07 or after you may be eligible for abursary or scholarship. In order for youruniversity or college to determine and pay any

non-repayable bursary or scholarship to whichyou may be entitled, we will need to sharesome of your personal, financial and coursedetails as well as information about youreligibility for student finance with them. Most

universities and colleges will not pay bursariesand scholarships if you do not give consent.

If you do not wish your details to be shared forthis purpose, please tick this box.

The relevant person(s) you indicated in section10 must complete section 11 as well as the

declaration(s) on page 29. Please pass this formto them now.

If you are a single independent student, pleaseturn to page 31 to finalise your application.

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Customer Reference Number:

i I agree that from the date I submit this formuntil the date when my loan(s), togetherwith all and any interest, penalties andcharges which apply, is fully repaid I willnotify the lender of any changes in thepersonal details (including National InsuranceNumber) and contact details I have providedas required in accordance with theregulations referred to in paragraph b.

j In the event that I leave the United Kingdomto reside outside the United Kingdom or thatfor any other reason I am outside the UK taxsystem, I undertake to inform the lender inaccordance with the regulations referred toin paragraph b and I undertake to providethe lender with my new and any subsequentcontact details until my loan, together withall and any interest, penalties and chargeswhich apply, is fully repaid.

k I agree to take all future action requested bythe lender and provide the lender with allinformation required to ensure repayment,in accordance with the regulations referredto in paragraph b.

l If I breach any of the terms under which anyloan(s) will be made I agree that I will beobliged to pay any charges and penaltieswhich may apply under the Teaching andHigher Education Act 1998 and theregulations made under that Act, asamended from time to time or successorlegislation and/or regulations.

m I understand that the Student LoansCompany (SLC) will check my NationalInsurance Number and personal details withthe Department for Work and Pensions(DWP). If I do not know my NationalInsurance Number, or if the number I providecannot be authenticated, DWP will trace andgive my number to the lender.

n If I have broken the terms of this contract Iagree that the lender may share informationheld about me and my account with anyperson, including the government or agovernment agency of another country, whomay assist in establishing my whereaboutsand/or in taking action to recoveroutstanding loan amounts.

I understand that any equipment I receivethrough DSAs must be used for my course ofstudy and SLC is not responsible for payingany repair costs.

I understand that if I do not take up mychildcare, or if I change to a childcareprovider who is not registered or approved, Iwill have to pay back any overpayment.

I understand that if I do not provide the

evidence of childcare costs within thetimescales set, I might lose my entitlement.Also if my payments to my childcare providerare different from the estimates I provide, Iunderstand that further payment willincrease or decrease accordingly, or if nofurther Childcare Grant payments are due tobe paid to me, I may be liable to repay anydifference.

I confirm that neither I nor my husband,wife, civil partner or cohabiting partner have

chosen to receive support for childcare fromthe childcare element of the Working TaxCredit and I agree to tell SLC immediately if Ior my husband, wife, civil partner orcohabiting partner does receive this support.


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financial details for the tax year2008-09 for parents and partners

/ / / /

You do not have to disclose your financial information to the student.

If you would like to provide it separately, you can download a 'Financial Assessment form 2010/11,for parents and partners providing financial details for the first time' from

www.direct.gov.uk/studentfinance and return it to us.Alternatively, you can have the form sent to you by ticking this box:

Person 1: Send me a separate form Person 2: Send me a separate form

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To complete this section you must provide details in Parts A - D:

Part A Your personal details Part B Data sharing and you

Part C Your financial information Part D Your dependants

Person 1

Your Customer Reference Number(If you have one)

Relationship to the student

Title

Forename(s)

Surname

Date of birth

Place of birth(name of town or village exactly as it appearson your birth certificate or passport)

Home address

PostcodeHome telephone number

Email address

Person 2

Your Customer Reference Number(If you have one)

Relationship to the student

Title

Forename(s)

Surname

Date of birth

Place of birth(name of town or village exactly as it appearson your birth certificate or passport)

Home address

PostcodeHome telephone number

Email address

Tick Tick


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Person 1

Person 2

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- -

This year it may be possible to share the information that you give us with other Government

bodies, allowing us to gain the most accurate information possible. This can only be done if youhave a valid National Insurance (NI) Number. n

Please provide your NI Number below:

I have an NI Number I do not have an NI Number

If you do not have a NI Number because you

receive non-UK taxable income, pleaseprovide the equivalent financial informationin pounds sterling and provide theappropriate financial evidence.


Tick Tick

go to Part CYou are now ready to provideyour financial information. Pleasego to Part C

You are now ready to provideyour financial information. Please


25/32SFE/PN1F/1011


Did you receive any income from salary,wages, occupational pensions or taxable statebenefits?

Total income received:

Did you receive any income fromSelf-employment?

Combined total income showing on yourSA103 and/or SA200 forms:

Total income showing on your SA104 form:

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Please give financial details for the tax year from 6 April 2008 to 5 April 2009.

Answer 'Yes' or 'No' to all 17 questions in Part C, providing income details where applicable.Please note that if you leave any questions blank we will not be able to process this application.

Did you receive Working Tax Credits orChild Tax Credits?

Did you receive Income Support?

How to answer questions 3 - 14

If you answer 'Yes' to any of these questions you will need to provide the total amount ofincome you receive for that income type.

If you need help to calculate the total income you should refer to the guidance notes.

Where any amount is entered, evidence for that amount must be provided.

If you answer 'No' to a question, this means you are telling us that you did not receive anyincome from that particular income type.

n

n

n e

n e

e


26/32SFE/PN1F/1011

Did you receive any income from a StateRetirement Pension?

Total non-lump sum amount received:

Total lump sum amount received:

Were you a Minister of religion?

Total income (minus expenses not includedon your P60 or P11D):

Yes No Yes No

Person 1 Person 2

Did you receive any income from savings andinvestments?

Combined total income showing on yourSA100 and SA200 forms or on your bankstatements/letters if you were not SelfAssessed:




Did you receive any taxable benefits in kind?

Total income from taxable benefits in kind:

Did you receive any other taxable income orlump sums?

Total other taxable income or lump sums:

Did you receive any income from propertylettings?

Total income from property lettings:

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2


Yes No Yes No

Person 1 Person 2

n e

n e

n e

n e

n e

n e


27/32SFE/PN1F/1011

Yes No Yes No

Person 1 Person 2

Did you receive any income from UK trusts?

Total income from UK trusts:

Did you receive any foreign income?

Total foreign income:

Did you receive any income from an OverseasPension?

Total income from an Overseas Pension:

Did you receive any other overseas incomeand gains?

Total income from other overseas income and

gains:

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Did you pay any private pensioncontributions?

Total private pension contributions you paid:

Did you pay any Additional VoluntaryContributions (AVCs)?

Total Additional Voluntary Contributionsyou paid:

Did you have any allowable expenses onwhich you claimed tax relief?

Total allowable expenses on which youclaimed tax relief:

n e

n e

n e

n e

n e

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Person 1 Person 2


n e

n e


28/32


SFE/PN1F/1011

Identify any person who will be wholly or mainly financially dependent on you.

Child dependants NOT in further or higher education in academic year 2010/11

Include unearned income for ALL dependants. Only include earned income details for persons

aged 16 and over. Do not count casual earnings of persons under 16.

Income for the yearDate of birthFull name

(DD MM YYYY)

Child dependants in further or higher education in academic year 2010/11

Do not include the applicant when completing this question.

If the student is your partner, please include any children named in Section 8 of this form if

they have applied for student finance.

School, college oruniversityDate of birthFull name Course

(DD MM YYYY)

n

n

Are they receivingfinancial support?If so, from whichauthority ororganisation?


29/32SFE/PN1F/1011

Before signing, you should read the Data Protection Statement in the notes that accompany this form.

This application for financial support may be delayed unless you sign and date this declaration.

I confirm that to the best of my knowledge and belief, the information I have provided is trueand complete. If it is not I understand I might be prosecuted and financial support withdrawn.

I agree to supply any further information in relation to the applicants application for financialsupport that SLC may ask for and agree to tell them immediately if my circumstances change inany way that might affect this application for financial support.

Date:


Your signature:

/ /

X

Person 1

Date:


Your signature:

/ /

X

Person 2

Your decision about bursary and scholarship datasharing consent will not affect the student'sentitlement to any other financial supportavailable.

In order for a university or college to determineand pay any bursary or scholarship towhich the student(s) you are supporting may beentitled, we will share some of your personal andfinancial details with them.


Your decision about bursary and scholarship datasharing consent will not affect the student'sentitlement to any other financial supportavailable.

In order for a university or college to determineand pay any bursary or scholarship towhich the student(s) you are supporting may beentitled, we will share some of your personal andfinancial details with them.


n

n

You must now pass this form back to the student.!

nn


30/32SFE/PN1F/1011

Additional Notes

If you are providing extra information below please clearly mark what section and question numberthe information is about.


31/32SFE/PN1F/1011

Voluntary questions

The following questions are voluntary - you do not have to answer them. Whether or not youanswer will not affect our assessment of your entitlement to financial support. If you answer bothquestions a and b, the information will be used to help the Department for Business, Innovation andSkills develop their policies in the future. Your local authority will also use your answer to question bto improve their ability to deliver suitable and accessible educational services that meet the varied

needs of their communities in the future.

Do any of your parents (as definedabove) have any higher educationqualifications, for example degreesand diplomas or certificates of highereducation?

How would you describe your ethnicorigin?

White

Black or Black British

Mixed

Chinese or other ethnic group

Asian or Asian British

Yes No Dont know

British

Irish

Any other white background

African

Caribbean

Any other black background

Chinese

Any other

White and black Caribbean

White and black African

White and Asian

Any other mixed background

Indian

Pakistani

Bangladeshi

Any other Asian Background

Your parents' education (this includes your natural parents, your adoptive parents, yourstep-parents, partners of your parents, and your guardians).


32/32

Before returning this form, please make sure you have done the following:

Fully answered all questions that apply to you.

Enclosed all evidence items. Any original evidence will be returned to you as soon as

possible.

Signed and dated the relevant declaration(s).

Within 6 weeks of returning your completed application form with all the relevant evidence, youwill be sent a letter showing the amount of financial support you will receive.

Student Finance EnglandPO Box 210

Darlington

DL1 9HJ

You must return your completed form to the address shown below.

e

If you are applying for student finance which does not require any financial information to beprovided, you must return your form to us by 23 April 2010 in order to ensure you receive your first

payment at the start of term.

If you are applying for student finance which does require financial information to be provided,you must return your form to us by 25 June 2010 in order to ensure you receive your firstpayment at the start of term.

If you miss this deadline, your application will be processed as soon as possible, but your firstpayment may not be available at the start of term.

This form should be returned within 9 months of the start of your academic year, otherwise youmay lose your full entitlement to student finance.

Documents

STUDENT FINANCE Applcation Form