student finance wales EMA Education Maintenance Allowance Application Form for 2013/14 SFW/EMA/F/V1314/A

Transcription

1 student finance wales EMA Education Maintenance Allowance Application Form for 2013/14 /A

2 how to complete this application form Student You need to: Complete sections 1 to 8 of this form All EMA payments will be paid into a bank or building society account in your name. If you haven't already got a bank account you should open one while you apply for EMA. Sign your agreement in Section 8 You must send your original birth or adoption certificate and proof of address Parent(s)/guardian(s) or partner You need to: If you forget to send your evidence, this will delay your EMA application. Complete sections 9 and 10 of this form If you aren't financially dependent on your parent(s) or guardian(s) we need details of your income, and of your partner (if applicable). Sign your agreement in Section 11 Send your original financial evidence for tax year The guidance notes list the types of financial evidence you can send. remember: You must send in original evidence to support your application when you see this icon Read the guidance notes when you see this icon n e If you need further information: The little book of EMA (available from schools/colleges, Careers Wales or to download from go to or EMAWales@slc.co.uk or call us on or by textphone You can order forms and guides in Braille, large print or audio by ing us your name and address along with your message about what format you require to brailleandlargefonts@slc.co.uk or you can telephone us on Please note, the address can only deal with requests for alternative formats of forms and guides. You must have sent your application, information and all evidence by 31 August This is the last date we can accept your information and evidence. 2

3 INTERNAL REFERENCE NUMBER: (For internal use only) Student section 1 your details If you are an existing EMA student, please provide your Customer Reference Number: Q1. Title n Mr Mrs Miss Other First name(s) Surname/Family name Sex Male Female DAY MONTH YEAR Date of birth In which town or city were you born? e Send your original birth or adoption certificate to prove your identity. Q2. Home address n You must usually live in Wales to be! eligible for EMA. Postcode Home telephone number Mobile telephone number (We may contact you by text message) address e Send proof of address in Wales (if you live with your parent(s)/guardian(s) this can be in their name). This can be a Tax Credit Award Notification (TCAN) or a utility bill (like a gas or electricity bill dated within the last three months). You can see an example TCAN on page 10 of the guidance notes. 3

4 Student section 1 your details security details Q3a. Please provide a secret answer. It is important you make your secret answer easy to remember as we will ask you to confirm this whenever you call us. Q3b. Please provide a hint question to remind you of your secret answer. For example, if you chose Superman as your secret answer then your hint question could be What is the name of my favourite superhero? If you ever forget your secret answer we will ask you this hint question to help you remember it. Student section 2 your school or college details Please enter the details of the school or college where you intend to study from September If you don t know where you will be studying from September 2013, just give the details of the school or college you are currently attending and you can call us to let us know where you will be studying later. Q1. Name of school or college Campus Q2. School or college address Postcode 4

5 Student section 3 your nationality and residency details n the option that best describes your status and follow the instructions. e You must provide evidence of your Nationality. Examples of evidence items can be found in the guidance notes. Q1. I am a UK national OR I have Settled Status or 'Indefinite leave to Enter or Remain' in the UK Have you been ordinarily resident in: the UK the EU/EEA Switzerland for 3 years prior to the first day of your course? Yes If Yes go to section 5 No If No go to section 4 Q2. I am an EU national Have you been ordinarily resident in the UK for 3 years prior to the first day of your course? Yes If Yes go to section 5 No You are not eligible for EMA Q3. I have, or a family member * has been granted Leave to enter or remain for; Humanitarian Protection, Discretionary Leave or Exceptional Leave to enter or remain in the UK Have you been ordinarily resident in the UK since this status was awarded? Yes If Yes go to section 5 No You are not eligible for EMA Q4. I have or a family member * has, Refugee status in the UK or EU temporary protection status in the UK Have you been ordinarily resident in the UK since Refugee status was awarded? Yes If Yes go to section 5 No You are not eligible for EMA * Your family member means your husband, wife, civil partner, parent or step-parent. 5

6 Student section 3 your nationality and residency details n e You must provide evidence of your Nationality. Examples of evidence items can be found in the guidance notes. Q5. I am a child of a Swiss national Will your Swiss national parent be living in the UK on the first day of your academic year? n Yes If Yes go to section 4 No If No go to Q6 Q6. I am, or a family member * is an EEA or Swiss national who is working/has worked or is looking for work in the UK Have you ordinarily been resident in: the UK the EU/EEA Turkey Switzerland for 3 years prior to the first day of your course? Yes If Yes go to section 5 No You are not eligible for EMA Q7. I am a child of a Turkish national who is working/has worked in the UK Have you ordinarily been resident in: the UK the EU/EEA Turkey Switzerland for 3 years prior to the first day of your course? Yes If Yes go to section 5 No You are not eligible for EMA Q8. None of these n You are not eligible for EMA * Your family member means your husband, wife, civil partner, parent or step-parent. 6

7 Student section 4 your residency history Q1. Details of your residence for the three years before the start of the first academic year of your course. First address From DAY MONTH YEAR To DAY MONTH YEAR Why were you there Second address From DAY MONTH YEAR To DAY MONTH YEAR Why were you there 7

8 Student section 5 your independence details You should answer every question in this section. Q1. Do you live apart from your parent(s)/guardian(s) and have no contact with them? n Yes No e You must provide evidence of your independence. Examples of evidence items can be found in the guidance notes. Q2. Are you living under Local Authority care? (for example, with foster parents) n Yes No Q3. Do you receive Income Support or Income Based Employment and Support Allowance in your own name? n Yes No Q4. Are you responsible for a child? n Yes No Q5. Are you currently a young person in custody/detention within the Youth Justice System? n Yes No If you answered Yes to any of the questions above you may be considered Independent. If you answer 'No' to all of the questions above you are considered Dependent. Dependent students If you are a dependent student your parent(s)/guardian(s) need to complete sections 9 and 10. Independent students If you answered Yes to Q1. then you and your partner (if applicable) must complete sections 9 and 10. Independent students For all other independent students, sections 9 and 10 don t have to be completed. Student section 6 your UK bank or building society account details This account must be in your own name and be able to accept direct credits. Missing or incorrect bank or building society details will result in your payments being delayed. If you have any exceptional circumstances which prevent you from opening a bank or building society account in your own name please tick here. If you ticked the box you will need a third party to complete this section with their bank details so that we can pay you EMA. Account holder's name Sort code Account number Building society roll number (if applicable) 8

9 Student section 7 consent to share n The information you provide on this form will be provided to the Welsh Government, Student Loans Company (SLC) or any other institutions used by the Welsh Government for the purposes of administering your EMA application. These bodies may use this information for market research purposes. If you do not consent to your information being used for market research tick here. Important information if you live with your parent(s)/guardian(s) or a partner: It is important that we know if you will let us talk about your application and award with your parent(s)/guardian(s) or partner. We cannot give out information about your application and award to anyone without your agreement. I consent to the EMA Wales Customer Services Team providing details of the progress of my application and award to the person named as person 1 in section 9 of this application form. Yes No and, if appropriate I consent to the EMA Wales Customer Services Team providing details of the progress of my application and award to the person named as person 2 in section 9 of this application form. Yes No Student section 8 student agreement We will not be able to process your application for EMA unless you sign and date this agreement. You should also read the Data Protection Statement, on page 12 of the guidance notes that accompany this form. The statement sets out who will use the information given on this application form and what they will use it for. I confirm that the information I have given on this form is correct and complete to the best of my knowledge and belief. I confirm that I have submitted supporting documentation in accordance with the guidance notes. I understand that any attempt to dishonestly obtain EMA shall be treated as fraud and may result in criminal and/or civil proceedings against me. now sign here: Your full name (in BLOCK CAPITALS) Your signature X Date / / 9

10 Student student checklist Have you: answered all the questions that apply to you in sections 1 to 7? If you don't answer all the questions we will have to write to you to ask you for more information. This will delay your application for EMA. Have you: included all the original evidence we need with this form? If you don't send the original evidence requested we will have to write to you to request the evidence. This will delay your application for EMA. Have you: signed and dated the student agreement in section 8? If any of your circumstances change please call us on next steps for: Dependent students Remember if you're dependent this means you live with your parent(s)/guardian(s). Now give your application to your parent(s)/guardian(s) to complete. Independent students If you answered Yes to Q1. in section 5 then you and your partner (if applicable) must complete sections 9 and 10 where you see this sign. Parent/Guardian/Partner 10

11 Parent/Guardian/Partner section 9 financial details n You should complete this section if You are the parent(s)/guardian(s)/partner of a student or you are an independent student. If you are an independent student enter your income details under person 1. Your partner (if applicable) should enter their details under person 2. Please give financial details for the tax year 6th April 2012 to 5th April Where you tell us an amount, you must provide evidence to support it. It is essential that you provide accurate and complete income details to make sure you/the student receives the correct amount of EMA. If you need help with any questions you should refer to the guidance notes each time you see this icon. n person 1 n person 2 n Q1. Relationship to student First name Surname/Family name benefit income Q2. Has your household been issued with a Tax Credit Award Notification for tax year (other than version 'R') Yes No if 'Yes', enter an amount Enter your total annual household income as it appears on your Tax and go to section 10 Credit Award Notification Q3. Is either person 1 or person 2 in receipt of Income Support or Income Based Employment and Support Allowance Yes No if Yes, go to section 10 e You must provide evidence for every question you enter an amount for. Types of evidence you must send can be found in the guidance notes. If you don t send the correct evidence this will delay the application for EMA. 11

12 Parent/Guardian/Partner section 9 financial details employment income Q4. Please provide information for tax year : Salaries and wages Self-employment income Taxable Social Security Benefits person 1 person 2 Other income: Type person 1 person 2 Type Type Type TOTAL EMPLOYMENT INCOME person 1 person 2 deductions person 1 person 2 Q5. Private pension contributions Additional Voluntary Contributions (AVCs) Wages for domestic help because of incapacity Any other expenses connected with employment TOTAL DEDUCTIONS Q6. TOTAL INCOME n (This is your Q4. TOTAL EMPLOYMENT INCOME minus Q5. TOTAL DEDUCTIONS) e You must provide evidence for every question you enter an amount for. Types of evidence you must send can be found in the guidance notes. If you don t send the correct evidence this will delay the application for EMA. 12

13 Parent/Guardian/Partner section 10 family details! Only complete this section if the following applies to you: The household income is between 20,817 and 23,077 and You have a young person(s) age 20* or under, other than the applicant, who will qualify for child benefit or are in full time further education/training and qualify for child benefit, and live in the household Q1a. Is your household income 20,817 or less per year? n Yes - go to section 11 No - go to Q1b. b. Are there any young people in your household who are under the age of 20* (other than the applicant) who: qualify for child benefit; or are in full-time education or training and qualify for child benefit. Yes - go to Q1c No - the applicant is not eligible for EMA c. Is your household income 23,077 or less per year? Yes - go to Q1d No - the applicant is not eligible for EMA e You will need to send us the evidence about the young person/people in your household to show their date of birth and that they live in your household. The types of evidence you can send can be found in the guidance notes. d. Enter details below of any young people under the age of 20* (other than the applicant) in your household. Full name(s) of young people under 20 Date of birth DD MM YYYY * Age 20 or under on 1 September

14 Parent/Guardian/Partner section 11 parent(s)/guardian(s)/partner agreement We will not be able to process this application for EMA unless you sign and date this agreement. You should also read the Data Protection Statement, on page 12 of the guidance notes. The statement sets out who will use the information given on this application form and what they will use it for. I confirm that the information I have given on this form is correct and complete to the best of my knowledge and belief. I understand that any attempt to dishonestly obtain EMA shall be treated as fraud and may result in criminal and/or civil proceedings against me. person 1 Your full name (in BLOCK CAPITALS) person 2 Your full name (in BLOCK CAPITALS) Your signature X Your signature X Date / / Date / / parent(s)/guardian(s)/partner checklist Before you return this form, have you? Answered all the questions that apply to you in sections 9 and 10? If you don't answer all the questions we will have to write to you to ask you for more information. This will delay the application for EMA. Attached original evidence items to the application form if applicable? If you don't send the original evidence requested we will have to write to you to request the evidence. This will delay the application for EMA. Have you checked the agreement(s) above are signed and dated? If any of your circumstances change please call us on

15 ! 3 things to remember: 1 check the postage Make sure the application form and envelope are weighed and that you have paid the correct postage before you post your EMA application form We recommend that you obtain free proof of postage when sending your form to us. If you don t pay the correct postage this could result in late payment of your EMA. This may also result in a delay in us returning any evidence items to you. 2 send the form You must return your completed form and original supporting evidence to the address shown below as soon as possible. If you don't have all the evidence we need send us your application now and send us your evidence as soon as you have it. EMA Wales Customer Services PO Box 5596 Glasgow G52 9BR If you have not heard from us two weeks after sending your form, please contact us on If you have hearing difficulties, and wish to speak to an advisor using a textphone, please contact us on get paid on time To make sure your EMA application is assessed and ready for the start of term send your completed form back to us, with all the appropriate original evidence, by June other information and dates: 8 weeks from the start of your course You can only get payments backdated to the start of term if you return the completed form, and appropriate original evidence, within 8 weeks of the start of your course. 31st August 2014 You should return your application form and evidence as soon as possible, however this is the final date that we can accept any information and evidence from you to be eligible for EMA in academic year 2013/14. 15

16 equal opportunities monitoring voluntary questionnaire The following questions are voluntary you do not have to answer them. Whether you answer them or not will not affect your application for an EMA. If you do answer, the information may be used to help the Welsh Government develop its policies in the future. Q1. Do you consider yourself to have a disability? Yes No Q2. What do you consider your nationality identity to be? (Choose as many or as few as apply). Welsh Irish English British Scottish Other Q3. Choose ONE section from A to E, then tick the appropriate box to indicate your ethnic group. A White British PLEASE RETURN THIS COMPLETED QUESTIONNAIRE WITH YOUR APPLICATION FORM Any other white background B Mixed White and Black Caribbean White and Black African White and Asian Any other mixed background C Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background D Black or Black British Caribbean African Any other black background E Chinese or other ethnic group Chinese Any other 16