BURSARY FUND APPLICATION FORM
Return form with supporting documents to studfin@waltham.ac.uk
LEARNERS MUST BE OVER 16 BUT UNDER 19 YEARS OLD ON 31 AUGUST 2019 TO APPLY. Learners aged 19 or over may be eligible to receive a discretionary bursary but only if they:
• are continuing on a study programme they began aged 16-18 (‘19 continuers’) or
• have an education, health and care plan (EHCP)	16 - 18	
	Academic Year
2020/21	

Learner Details								       		              SECTION 1

ID Number

First Name……………………………………………………………    Surname…………………………………………………………….

Course    										       		 SECTION 2

Name of Course ………………………………………………………………………………………………………………………………….

Vulnerable Bursary (Evidence Required)			                                                                   SECTION 3                                                                                                  

         I am in care              

         I am a care leaver          

         I personally receive Income Support or Universal Credit payment          

          I personally receive income support or universal credit payments and I receive Disability Living Allowance (DLA)             
         or Personal Independence Payments (PIP)

Discretionary Bursary (Evidence Required)								 SECTION 4

       I am from a non-working household and in receipt of Free School Meals (FSM)

       Our house income is less than £25,000

Travel									                           		SECTION 5

Transport for London - 16+ Zip Oyster Photocard 
Learners aged 16, 17 on 31 August 2020 living in a London Borough can get free bus and discounted travel on the tube, DLR and overground. Learners aged 18 on 31 August 2020 who are still in full time education can also apply.
If you do not live in a London Borough and are under 18 years of age you may qualify for half price travel.

Are you applying for help with additional travel costs?   Yes 	        No      

If yes, please provide details of your journey:

Travelling from……………………………………………………………….  Travelling to……………………………………………………………………….

Supporting Statement (optional)								              SECTION 6

Use this section to provide any relevant information to support your application.

Learners Bank Account    									        	 SECTION 7

Name of account holder………………………………………………………………………………………………………………………..

Name of your bank/building society…………………………………………………………………………………………………………

	

	

Sort code: 

	

	

Account number: 

 Saving & Credit Union accounts (only) reference number ……………………………………………………………………………

Declaration											              SECTION 8

I declare that: 
1.	I have read and understood the guidelines and conditions for applying to the Bursary Fund.	
2.	Student Finance will assess the individual financial award for free meal, transport, books, equipment, field trips, industry placement and other course related cost.
3.	There is a possibility of no award or limited award. The College reserves the right to vary or withdraw the offer of Bursary subject to available funds and qualifying conditions.
4.	Giving false or incomplete information that leads to incorrect/overpayment may result in future payments being stopped and any incorrectly paid funds being recovered. This may result in disciplinary proceedings.
5.	If a Learner is in receipt of Disability Living Allowance (or Personal Independence Payments) and Employment Support Allowance, parents can no longer receive certain household/family benefits for that child, such as child benefit. 
6.	I agree that details of my award and application, including personal information, may be revealed, on request, to statutory Government bodies such as the Benefits Agency, Local Education Authority, etc.
7.	I understand that if I withdraw from my course before the completion date, I will be required to repay an appropriate amount of any Bursary received.
8.	I understand that I am expected to attend 100% of my classes to receive full bursary.
Learner Signature _________________________________________________   Date _____________________