ptg1 - student finance wales€¦ · this form should be completed in conjunction with the ptg1...

1SFW/PTG1F/1314

Your forename(s) Your surname

Customer Reference Number (if you have one)

The answers you give on this form will help us decide whether you are eligible to receivea grant and if so how much you are entitled to under the Education (Student Support)(Wales) Regulations 2012 (as amended).

This form should be completed in conjunction with the PTG1 notes. The notes will give you extrainformation to help you complete the form correctly so that there are no delays with processingyour application due to incorrect answers, missing information or lack of evidence.

Please refer to the guidance notes when you see this icon

Please supply evidence when you see this icon

Disabled Students’ Allowances (DSAs)If you want to apply for DSAs you need to complete this form then complete a disabled Students’Allowances (DSA) application form. Please send me a DSA form

Have you received grants or Disabled Students’ Allowancesfor this programme of study before? Yes No

Childcare GrantDo you want to apply for a Childcare Grant? Yes No

Deadline – You can apply for a part-time grant at any time in the academic year provided youare within the time limit. The time limit for applying is usually nine months from the start of theacademic year.

Application forgrants for part-time study2013/14

This form is also available fromwww.studentfinancewales.co.uk

PTG1

SFW/PTG1F/13142

What sections do I need to complete?All students need to complete

sections 1, 2, 4, 5, 7, 8 & 9and the declaration

Applying for part-time Student Finance

I am applying for the first time, do Ineed to complete anything else?

Yes, you also need to completesection 3

Does my university/college need tocomplete anything?

Yes, they need to complete section 6

Where do I return my application?You should return it to your local authority(LA) at the address shown on the back of

this form, the accompanying letter withthis form or on the contact list available

online atwww.studentfinancewales.co.uk

Who should complete this form?New and returning part-time students,returning full-time distance learners*

* If you study full-time you should only complete this form if you are studyingthrough distance learning by choice and not because you have a disabilitywhich prevents you from attending your university/college in person.

SFW/PTG1F/1314 3

a

personal details 1section

Title Mr Mrs Miss Ms

Forename(s)

SurnameSex Male Female

Date of birthPlease complete these questions with the details exactly as stated on your birth certificate or passport.

Place of birth (the name of the town or village)

Nationality

Marital status

Please tick one box:SingleLiving with a partnerMarried/civil partnership Please give the date of marriage/civil partnership.SeparatedDivorced/dissolved civil partnershipWidowed/surviving civil partner

Will you be 25 or over on the first day of the academic year? Yes No

YEARMONTHDAY

YEARMONTHDAY

Please give your current home address. Please also give your term-time address if youknow it.

Home address

PostcodeHome phone number

Term-time address

PostcodeDate on which you will move to this address

Mobile phone number

Email address

YEARMONTHDAY

Contact status

b1

c

b2

SFW/PTG1F/13144

Will you be getting funding from any other source to meet the costsof your course in 2013/14? Yes No

Have you received a grant for part-time study for this programme ofstudy for any academic year up to and including 2012/13? Yes No

Do you hold a first degree from an educational institution in the UK? Yes No

Have you ever had any other loans from the Student Loans Company (SLC)? Yes No

If ‘Yes’, are you behind with the repayments? Yes No

Did you receive any loans from the Student Loans Company (SLC) when you were under 18? Yes No

If ‘Yes’, have you signed credit agreements for all of them? Yes No

a

if No go to section 3

b

c

d

e

if Yes go to section 4

If ‘Yes’, please givedetails of this funding.

previous loans or financial support2section

SFW/PTG1F/1314 5

a1 Are you a UK national?

a2 Are you an EU national?

a3 Are you the child of a Swiss national?

a4 Will your Swiss national parent be living in the UK on the first day of the academic year?

section

3residence

If Yes go to b1

Please do not complete this section if you have previously applied forstudent finance for this programme of study.

Yes No

go to section 4

If No go to a5

Yes No

Yes No

a5 Are you or your:• husband, wife, civil partner; or• parent(s), a step-parent; or• child, son or daughter-in-law, child’s civil partnera European Economic Area (EEA) national or Swiss national who is working, has worked or is looking for work in the UK?If 'Yes', please give details below.

You should also give details of your previous studies.

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

If ‘Yes’, please give details.

a6 Do you have ‘settled status’ in the UK?

If ‘Yes’, give the date you received this status.

a7 Have you or your:• husband, wife, civil partner; or• parent(s), a step-parentbeen granted ‘refugee status’ by the UK Government?

If ‘Yes’, and if applicable, give the date this status is due to expire.

If No go to a6

go to b2

YEARMONTHDAY

If No go to a7

go to b2

YEARMONTHDAYgo to b2

If No go to a8

Yes No

Yes No

Yes No

Yes No

If Yes go to b2Yes No

SFW/PTG1F/13146

residence3section

continued

a8 Have you or your:• husband, wife, civil partner; or• parent(s), a step-parentbeen given ‘leave to enter or remain’ in the UK as aresult of a failed asylum application, or discretionary leave where no application for asylum has been made?

If ‘Yes’, and if applicable, give the date this status is due to expire.

YEARMONTHDAYgo to b2

Yes No

b1 In the three years prior to the start of the first academic year of yourcourse, did you live outside the UK and Islands at any time?

b2 Give details of your residence for the three years before the start of the first academic year of your course.Full address Why were you there?

b3 Did you move to Wales wholly or mainly for the purpose of receiving education?

b4 At any time since 1 September 2010 has:• either of your parents, step-parents, guardians; or• your husband, wife, civil partnerlived 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 below.Full address Why did they live there?

Yes No

YEARMONTHDAY

FromYEARMONTHDAY

To

If you require further space to provide your answer, please give the details requested abovein the Additional notes pages at the back of this form.

If No go to b3

YEARMONTHDAY

FromYEARMONTHDAY

To

YEARMONTHDAY

FromYEARMONTHDAY

ToYEARMONTHDAY

FromYEARMONTHDAY

To

Yes NoIf Yes please contact your LA for advice

Yes No

! If you answered ‘No’ to all the residency and nationality questions in thissection you are not eligible for student finance from Student Finance Wales. Do not continue with this application.

SFW/PTG1F/1314 7

about your courseUniversity/college name and addressIf the course is at a university that is made up of a number of colleges, give the name of thecollege first, followed by the name of the university (for example, Hatfield College, University ofDurham).

Postcode

If the course is franchised to another university/college, give the address of the otheruniversity/college.

Postcode

Give the name of the course you will be undertaking in 2013/14. Give the course subject (forexample, Information Systems). If you are following a combined studies or modular course, listall the subjects.

Qualification you expect to gain (for example, BSc Physics)

Course start date

Course end date

Course length (years)

Current year of course in academic year 2013/14?

First Second Third Fourth Fifth Sixth Seventh Eighth

First time applicantsIs your course a part-time postgraduate Initial Teacher Training (ITT) course? Yes No

YEARMONTH

YEARMONTH

a

b

c

e

f

gh

i

d

4section

If returning applicant go to section 5

SFW/PTG1F/13148

your UK bank or buildingsociety account details5

section

UK bank/building society account details

Sort code

Account number

Building society roll number

_ _

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 grantpayment or bursary (if applicable) being delayed.

SFW/PTG1F/1314 9

University/college sectionUniversity or college staff should check the student’s answers to section 4 beforesigning and stamping this section.Actual course fee to be charged to the student forthe 2013/14 academic year. NB if you are claiming aPart-time Undergraduate Fee Waiver from HEFCWon behalf of the student you will need to insert ‘nil’.

Course start date for 2013/14 academic year:

Course end date for 2013/14 academic year:

SLC or UCAS code for the institution:

I confirm to the best of my knowledge and belief that:

• the student named in section 1 is undertaking the course named in section 4.

• the student is expected to complete this part-time (PT) course in years.

• the equivalent full-time (FT) course would last years.

Intensity of study is calculated by dividing the number of years for FT by the numberof years for PT and multiplying this by 100. Therefore:

• the intensity of study for this course is

• the student's course is designated as eligible for financial support under Regulation 95 of the Education (Student Support) (Wales) Regulations 2012 (as amended).

your university or college

go to section 7

£

FT

PTX 100 = %___________

6section

YEARMONTHDAY

YEARMONTHDAY

• Your university or college need to complete and sign this section. If they do not complete this section your application for student finance will be delayed.

Student information

Student circumstance University/college action required

You are a new student or this is your firstapplication for student finance

To confirm that you have been undertakingyour course in academic year 2013/14 for aminimum of two weeks

You are a continuing student To confirm that you have enrolled on yourcourse for academic year 2013/14

SFW/PTG1F/131410

University or college stamp

YEARMONTHDAY

Your phone number(including area code)

Your email address

Your signature

your university or college

Date

Your full name (in BLOCK CAPITALS)

Your position

6section

continued

SFW/PTG1F/1314 11

about your husband, wife, civil partner or partner

Please give details of your husband, wife, civil partner or partner.

Relationship to you Husband Wife Civil partner Partner

Title Mr Mrs Miss Ms

Forename(s)

Surname

Date of birth

Place of birth (the name of the town or village)

Home address

Postcode

Home telephone number (including area code)

Please ask your husband, wife, civil partner or partner to provide their Customer Reference Number, if they have one

a

b

c

YEARMONTHDAY

7section

SFW/PTG1F/131412

If you and your husband, wife, civil partner or partner are not receiving any benefits,please provide full financial details below.

financial details

b1

If you have ticked any of the boxes above go to section 9

a If you or your husband, wife, civil partner or partner are receiving one or more of the following state benefits, please tick the appropriate box.

Housing benefit

Local Housing Allowance

Council tax benefit

Income Support

Income-based Jobseeker’s Allowance

New Deal Allowance

Income-related Employment Support Allowance

When providing your financial details in this section you must answer every question,entering the amount of income received. You must provide financial details and evidence fortax year 2012-13. The only exception to this is if your course starts in July 2014 in which caseyou need to provide financial details and evidence for tax year 2013-14.If you have no income for a particular source, for example, income from pensions you mustenter 'None' or 'N/A' as the income received. Where you enter an amount other than 'None' or'N/A', you must provide evidence of that amount.

Type of income Amount received before tax (Gross income)

Gross income fromsalary/wages (beforedeductions) from 6 April 2012to 5 April 2013.

Income from self-employment

Bank and building society gross interest (before tax)

Other investment income before income tax

b2

b3

b4

8section

£ You £

£ You £

£ You £

£ You £

£ You £

Type

Type

Husband, wife, civil partneror partner

You


You






SFW/PTG1F/1314 13

financial details

Income from any property, lettings or rent

How much of this is through the rent a room scheme?

Any other type of income

Give details of any children who will be totally or mainly financially dependent on you during theacademic year 2013/14.

b5

Type of income Amount received before tax (gross income)

b6

c

£ You £

£ You £Type

£ You £Type

£ You £Type

£ You £Total income

£ You £

Child’s full name Date of birth Relationshipto you

Who will theylive with?

Income from allsources after incometax and socialsecurity contributions

YEARMONTHDAY

8section

continued








You

SFW/PTG1F/131414

a Are you a lone parent?

b Are you under 25, living with a partner and claiming for a Childcare Grant or Parents’ Learning Allowance?

c Total (estimated) income after income tax and National Insurance contributions have been deducted for academic year 2013/14.

How much of this will be Child Tax Credit for academic year 2013/14?

You: £

Your partner: £ You: £

Yes No

section

9 Parents' Learning Allowance, AdultDependants' Grant and Childcare Grant

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

If you are claiming for Parents' Learning Allowance, Adult Dependants’ Grant or the ChildcareGrant give an estimate of your husband's, wife's, civil partner's, partner's or other adultdependants’ income (after deductions) for academic year 2013/14.

Husband, wife, civil partner Other adult dependantor partner

Income from earnings

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 £ £ Other adult dependant

£ £ Other adult dependant



£

£ Other adult dependant£



£ Other adult dependant


Yes No

if Yes go to d

if No go to d

go to f

Your partner: £

Husband, wife civil partneror partner









SFW/PTG1F/1314 15

Husband, wife, civil partner Other adult dependantor partner

All other income

If other, what is it?

If you have provided financial details above specifically to claim for an Adult Dependants’ Grant, please indicate who you want to claim an Adult Dependants’ Grant for:

Your Your Your civil partner or partner Other adult husband wife (if you are 25 or over) dependant


e Give details of financial commitments you have before the start of the course which you, your husband, wife, civil partner or partner will continue to pay for you during your academicyear.

f If you are not applying for Childcare Grant

Do you, your husband, wife, civil partner or partner receive or expect toreceive, the childcare element of Working Tax Credit?

If ‘Yes’, you are unable to get a Childcare Grant. You can however, choose to receive a Childcare Grant instead of the childcare element of Working Tax Credit.

Type: £ Type: £

Type: £ Type: £

Yes No

section

9Parents' Learning Allowance, AdultDependants' Grant and Childcare Grant

continued

go to Declarations


SFW/PTG1F/131416

DeclarationsThis application for financial support may be delayed unless you, and the appropriate personnamed in section 7, sign and date the relevant parts.

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

Student declaration• I confirm that to the best of my knowledge and belief, the information I have given on this

form is true and complete and I understand that if I have given my local authority (LA) false information, or have not given them complete information, I may not receive financial support, any support I have had may be withdrawn and I could be prosecuted.

• I agree to give my LA any additional information they require to enable them to process my application and agree to tell them immediately if my circumstances change in any way that might affect my entitlement to financial support.

• I understand that if I do not tell my LA about any change in my circumstances, which may affect my entitlement, I may not be eligible to receive any payments that they have told me about, and that I may have to repay all or part of the financial support I have already received in the year.

• I agree that in the event of receiving an overpayment of financial support, I am obligated to repay any of this overpayment in full.

Your full name(in BLOCK CAPITALS)

Your signature DateYEARMONTHDAY

Your decision about bursary and scholarship data sharing consent will not affect yourentitlement to any other financial support available.

If you started your course in academic year 2006/07 or after you may be eligible for a bursaryor scholarship. In order for your university or college to determine and pay any bursary orscholarship to which you may be entitled, we will share some of your personal, financial andcourse details as well as information about your eligibility for student finance with them.

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

SFW/PTG1F/1314 17

Declaration for the person named in section 7• I confirm that to the best of my knowledge and belief, the information I have given on this

form is true and complete and I understand that if I have given the local authority (LA) falseinformation, or have not given them complete information, the student may have their financial support withdrawn and I could be prosecuted.

• I agree to supply any further information in relation to the applicant’s application for financialsupport that the LA may ask for and agree to tell them immediately if my circumstances change in any way that might affect this application for financial support.

Your decision about bursary and scholarship data sharing consent will not affect thestudent's entitlement to any other financial support available.In order for the applicant’s university or college to determine and pay any bursary orscholarship to which they may be entitled, we will share some of your personal and financialdetails with them.

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

You must now pass this form back to the student.

Now go to page 19 to finalise your application.

!

Your full name(in BLOCK CAPITALS)

Your signature DateYEARMONTHDAY

SFW/PTG1F/131418

Additional notesIf you are providing extra information please clearly mark what section and question theinformation is about.

SFW/PTG1F/1314 19

Voluntary questionsDo not complete the voluntary questions if you applied for student finance for this particularprogramme of study in any academic year up to and including 2012/13.

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 support. If you answer bothquestions a and b, the information will be used to help the Welsh Ministers develop their policiesin future. Your local authority will also use your answers to question b to improve their ability todeliver suitable and accessible educational services that meet the varied needs of theircommunities in the future.

Your parents’ education (this includes your natural parents, your adoptive parents, your step-parents, partners of your parents, and your guardians).Do any of your parents (as defined above) have any higher education qualifications, for example degrees and diplomas or certificates of higher education? Yes No Don’t know

a

b How would you describe your ethnic origin?White: British (Welsh) British (English)

British (Scottish) British (Other) Irish Any other white background

Black or Black British: African Caribbean Any other black background

Mixed: White and black Caribbean White and black African White and Asian Any other mixed background

Chinese or other ethnic group: Chinese Any other

Asian or Asian British: Indian Pakistani Bangladeshi Any other Asian Background

SFW/PTG1F/131420

ChecklistBefore returning this form please make sure you have done the following:• Fully answered all the questions that apply to you.

• Enclosed all the documents we have asked for as evidence where youhave seen this icon next to a question.

• Signed and dated the relevant declaration(s).

• Asked your university or college to stamp and sign the declaration in section 6 and return it to you. We will not be able to deal with your application unless this section has been completed.

You can apply for a part-time grant at any time in the academic year provided you are within thetime limit. The time limit for applying is usually nine months from the start of the academic year.

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.

You must return your completed form to your LA at the address shown either below oron the covering letter sent with this form. The address can also be found by goingonline to: www.studentfinancewales.co.uk and then selecting 'Find my local authority'.

Please remember to pay the correct postage.

ptg1 - student finance wales€¦ · this form should be completed in conjunction with the ptg1...

Documents