LEARNER SUPPORT FUND AND
ADVANCE LEARNER LOAN BURSARY 
APPLICATION FORM
Return form with supporting documents to studfin@waltham.ac.uk
Deadline for submitting your completed application: Friday 09 October 2020	19+	
	Academic Year
2020/21	

Student Details								       		              SECTION 1

ID Number

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

Course Information											SECTION 2

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

Status									                                                      SECTION 3

Are you an Asylum Seeker?   Yes 	No             

Advanced Learner Loan 							                                         SECTION 4

Are you on the Advance Learner Loan?      Yes             No  

If yes, will you require support for a learning difficulty or disability?  Yes              No  

Travel									                           		SECTION 6

Do you need help with travel costs?     Yes	    No           

Are you required to attend mandatory work placement?    Yes         No  

If yes, please explain why you need help with travel costs ……………………..……………………………………………………………………

…………………………………………………………………………………………………………………………………………………………………………………….

……………………………………………………………………………………………………………………………………………………………………………………..

Childcare Funding									                          SECTION 7   

To apply for help with childcare costs please speak to the Student Finance Team to make a separate application. Funding for childcare is subject to available funds.  

Supporting Statement (optional)								              SECTION 8

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

Student Bank Details										        	 SECTION 9

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

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

	

	

Sort code: 

	

	

Account number: 

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

Declaration										                         SECTION 10

I declare that: 
1.	I have read and understood the guidelines and conditions for applying to the Learner Support Fund and Advance Learner Bursary Fund.
2.	There is a possibility of no award or limited award. The College reserves the right to vary or withdraw the offer of funds subject to available funds and qualifying conditions.
3.	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.
4.	I understand it is my responsibility to tell the Department of Work and Pensions about any funding I receive, as this may affect my entitlement to some benefits.
5.	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.
6.	I understand that if I withdraw from my course before the completion date, I will be required to repay an appropriate amount of any funds received.
7.	I understand that I am expected to attend 100% of my classes to receive full bursary.

Learner Signature _________________________________________________   Date