EDUCATION MAINTENANCE ALLOWANCE (EMA) Applcaton Form Academc year 2015/16 www.ndrect.gov.uk Apply Now!
How to complete ths applcaton form Follow the nstructons, we ll tell you what questons you need to answer and what ones you can skp. You ll need to have your bank, buldng socety or credt unon detals to hand. Secton 8 wll ask about your household fnancal detals. Dependng on your stuaton, ether your parent(s) or you (and your partner, f you have one) wll need to complete ths secton. Whoever completes ths secton wll need ther Natonal Insurance number to hand. You need to complete all of the questons you re asked to. Any mssng nformaton wll delay your applcaton for EMA. Where we ask for evdence - we wll need t before your applcaton can be accepted. Any mssng evdence wll delay your applcaton for EMA. Use the notes Where you see ths you should check the notes for specfc nformaton to help you complete a queston or e secton. Where you see ths you need to send us evdence to support your applcaton. Use the notes to fnd out exactly what you need to send. All documents you send must be orgnals, we can t accept copes. We wll send your orgnals back to you. What f I can t send the evdence you need now? Return your applcaton wthout the evdence. By dong ths we can make a start on your applcaton, but we won t be able to pay you untl we see the documents we ve asked for. We ll wrte to you to confrm what documents we stll need from you. 2015/16 Calendar Aprl 2015 Applcaton forms avalable for download from www.ndrect.gov.uk May 2015 Applcaton forms avalable at your school or college June 2015 Return your applcaton wth all requred evdence before 30 June 2015 to make sure your EMA applcaton can be processed and ready for the start of your frst term September 2015 Term starts If you re applyng late, you need to apply before 30 September 2015 to be able to get your payments backdated to the start of term January 2016 2016 March 2016 We need to have receved your applcaton before 31 March 2016 for you to be elgble for EMA n academc year 2015/16 August 2016 We need to have receved all your nformaton and evdence before 31 August 2016 for you to be elgble for EMA n academc year 2015/16! 2 If your household ncome s 22,501 or more do not complete ths applcaton form - you wll not be elgble for ths allowance. EMANI/APP/1516
Secton 1 Agreements 1.1 Tck the statement that apples to you and follow the nstructon.! By authorsed thrd party we mean someone who s able to provde evdence from a publc body or a Power of Attorney confrmng ther status. I am the student completng ths form myself. Complete the Student Agreement below. I am an authorsed thrd party who s both: completng ths form on behalf of the student because they are unable to and I am authorsed to hold funds on behalf of the student. Complete the Authorsed Thrd Party Agreement A below. I am an authorsed thrd party who s only: completng ths form on behalf of the student because they are unable to. Complete the Authorsed Thrd Party Agreement B on page 4. I am an authorsed thrd party who s only: authorsed to hold funds on behalf of the student. Complete the Authorsed Thrd Party Agreement C on page 4. Student Agreement By sgnng ths agreement you are confrmng that: the nformaton you wll gve on ths form s correct and complete to the best of your knowledge and belef; you wll submt supportng evdence n accordance wth the accompanyng notes; you understand that any attempt to dshonestly obtan EMA shall be treated as fraud and wll be subject to dscplnary procedures nvolvng the Polce Servce of Northern Ireland (PSNI); you have read and understood the Data Protecton Statement ncluded on page 3 of the accompanyng notes; and you have read and understood these statements. Today s date Student full name (n BLOCK CAPITALS) Student sgnature Now skp to Secton 2 Thrd Party Agreement A By sgnng ths agreement you are confrmng that: the nformaton you wll gve on ths form s correct and complete to the best of your knowledge and belef; you wll submt supportng evdence n accordance wth the accompanyng notes; you are authorsed to act on the student s behalf and have enclosed evdence to prove ths; the student named n Secton 2 s unable to have a bank, buldng socety or credt unon account n hs/her own name; you wll provde correct bank, buldng socety or credt unon detals n your own name, are authorsed to hold funds on the student s behalf and have enclosed evdence to prove ths; you have read and understood the Data Protecton Statement ncluded on page 3 of the accompanyng notes; you wll use EMA payments made as a result of ths applcaton n accordance wth the student s nstructons; and you have read and understood these statements. Today s date Authorsed Thrd Party full name (n BLOCK CAPITALS) Authorsed Thrd Party Sgnature Now go to 1.2 EMANI/APP/1516/A 3
Secton 1 Agreements (contnued) Thrd Party Agreement B By sgnng ths agreement you are confrmng that: the nformaton you wll gve on ths form s correct and complete to the best of your knowledge and belef; you wll submt supportng evdence n accordance wth the accompanyng notes; you have read and understood the Data Protecton Statement ncluded on page 3 of the accompanyng notes; you are authorsed to act on the student s behalf and have enclosed evdence to prove ths; and you have read and understood these statements. Today s date Authorsed Thrd Party full name (n BLOCK CAPITALS) Authorsed Thrd Party Sgnature Now go to 1.2 Thrd Party Agreement C By sgnng ths agreement you are confrmng that: the student named n Secton 2 s unable to have a bank, buldng socety or credt unon account n hs/her own name; you wll provde correct bank, buldng socety or credt unon detals n your own name; you are authorsed to hold funds on the student s behalf and have enclosed evdence to prove ths; you have read and understood the Data Protecton Statement ncluded on page 3 of the accompanyng notes; you wll use any EMA payments made as a result of ths applcaton n accordance wth the student s nstructons; and you have read and understood these statements. Today s date Authorsed Thrd Party full name (n BLOCK CAPITALS) Authorsed Thrd Party Sgnature Now go to 1.2 1.2 Thrd Party detals e You need to send evdence to prove your authorsaton, read the notes to fnd out what you need to send. You must contact us f the student s contact detals change or f the student s nomnated thrd party s detals change durng the academc year. All correspondence wll contnue to be addressed drectly to the student. Forename(s) Surname Home address Postcode Home phone number Moble phone number Emal address 4 EMANI/APP/1516
INTERNAL REFERENCE NUMBER: (For nternal use only) Secton 2 Your detals 2.1 Customer Reference Number: (f you don t have one yet, leave ths blank) 2.2 Personal Detals Ttle e Complete these detals exactly as stated on your brth certfcate, passport or deed poll If any of your detals change durng the year you need to let us know You need to send evdence, read the notes to fnd out what you need to send. Mr Mrs Mss Other Forename(s) Surname Gender Male Female Date of brth Place of brth (the name of the town or vllage) 2.3 Contact Detals e You need to send evdence, read the notes to fnd out what you need to send. Home address Postcode Home phone number (We may contact you by text message.) Moble phone number Emal address 2.4 What was the name of your frst school? If you ever need to call us we ll ask you for the answer you gve to ths queston as a securty check, you need to remember the answer you gve! EMANI/APP/1516 5
Secton 3 Your payment detals 3.1 Are you completng ths secton as an authorsed thrd party who wll hold the student s EMA payments on ther behalf? No go to 3.2 Yes go to 3.3 By authorsed thrd party we mean someone who s able to provde evdence from a publc body or a Power of Attorney confrmng ther status. 3.2 Student payment detals Ths account must be n your name and be able to accept drect credts. You must provde your detals n full or we won t be able to pay you! Account holder s name (student) Sort code Account number Buldng socety roll/credt unon membershp number (f applcable) Now go to Secton 4 3.3 Thrd party payment detals Ths account must be able to accept drect credts. You must provde your detals n full or we won t be able to pay you! Account holder s name (thrd party) Sort code Account number Buldng socety roll/credt unon membershp number (f applcable) Now go to Secton 4 6 EMANI/APP/1516
Secton 4 Your school or college detals 4.1 Are you n recept of, or have you been approved to receve ether: a Further Educaton (FE) Award from the Department for Employment and Learnng No go to 4.2 Yes You are not elgble for ths allowance. Do not contnue wth ths applcaton. or a Department of Agrcultural and Rural Development (DARD) Bursary? 4.2 Gve detals of where you ntend to study from September 2015? Name of school or college If you don t know where you ll study, gve the detals for your current school or college. If these detals change or you change where you ll study you must let us know as soon as possble and no later than before the start of your frst term. Campus (f applcable) School or college address Postcode Now go to Secton 5 EMANI/APP/1516 7
Secton 5 Your natonalty and resdency detals 5.1 Are you a UK or ROI natonal? No Go to 5.2 Read page 5 of the notes to understand what we mean by ordnarly resdent. Yes Have you been ordnarly resdent n ether: the UK; or the EU/EEA; or Swtzerland for three years pror to the frst day of your course? No You need to send evdence, read the notes to see what you need to e send and then skp to Secton 6. Yes You need to send evdence, read e the notes to see what you need to send and then skp to Secton 7. 5.2 Do you have Settled Status n the UK? By Settled Status we mean: you have a rght of permanent resdence n the UK; or you have been granted ndefnte leave to reman; or you have a rght of abode n the UK No Go to 5.3 Yes Have you been ordnarly resdent n ether: the UK; or the EU/EEA; or Swtzerland for three years pror to the frst day of your course? Read page 5 of the notes to understand what we mean by ordnarly resdent. No You need to send evdence, read the notes to see what you need to e send and then skp to Secton 6. Yes You need to send evdence, read the notes to see what you need to e send and then skp to Secton 7. 8 EMANI/APP/1516
Secton 5 Your natonalty and resdency detals (contnued) 5.3 Have you or a famly member been granted Leave to Enter or Reman for Humantaran Protecton or Dscretonary Leave? Your famly member must be your husband, wfe, cvl partner, parent, step parent, chld or step-chld. Read page 5 of the notes to understand what we mean by ordnarly resdent. No Go to 5.4 Yes Have you been ordnarly resdent n the UK for three years pror to the frst day of your course? No Go to 5.4 Yes You need to send evdence, read the notes to see what you need to e send and then skp to Secton 7. 5.4 Do you or a famly member have Refugee status n the UK or EU temporary protecton status n the UK? No Go to 5.5 Yes Have you been ordnarly resdent n the UK snce ths status was awarded? Your famly member must be your husband, wfe, cvl partner, parent, step parent, chld or step-chld. Read page 5 of the notes to understand what we mean by ordnarly resdent. No Go to 5.5 Yes You need to send evdence, read the notes to see what you need to e send and then skp to Secton 7. 5.5 Are you an EU natonal? No Go to 5.6 Read page 5 of the notes to understand what we mean by ordnarly resdent. Yes Have you been ordnarly resdent n the UK for three years pror to the frst day of your course? No Go to 5.6 Yes You need to send evdence, read the notes to see what you need to e send and then skp to Secton 7. EMANI/APP/1516 9
Secton 5 Your natonalty and resdency detals (contnued) 5.6 Are you the chld of a Turksh natonal who s workng or has worked n the UK? Read page 5 of the notes to understand what we mean by ordnarly resdent. No Go to 5.7 Yes Have you been ordnarly resdent n ether: the UK; or the EU/EEA; or Turkey for three years pror to the frst day of your course? No go to 5.7 Yes You need to send evdence, read e the notes to see what you need to send and then skp to Secton 7. 5.7 Are you the chld of a Swss natonal? Read page 5 of the notes to understand what we mean by ordnarly resdent. No Go to 5.8 Yes Wll your Swss natonal parent be lvng n the UK on the frst day of the academc year? No go to 5.8 Yes Have you been ordnarly resdent n ether: the UK; or the EU/EEA; or Swtzerland for three years pror to the frst day of your course? No go to 5.8 Yes You need to send evdence, read the e notes to see what you need to send and then skp to Secton 7. 10 EMANI/APP/1516
Secton 5 Your natonalty and resdency detals (contnued) 5.8 Are you or a famly member an EEA or Swss natonal who s workng/has worked or s lookng for work n the UK? Your famly member must be your husband, wfe, cvl partner, parent, step parent, chld or step-chld. Read page 5 of the notes to understand what we mean by ordnarly resdent. No Go to 5.9 Yes Have you been ordnarly resdent n ether: the UK; or the EU/EEA; or Turkey; or Swtzerland for three years pror to the frst day of your course? No go to 5.9 Yes You need to send evdence, read e the notes to see what you need to send and then skp to Secton 7. 5.9 Tck the box whch apples to you. I have answered Yes to at least one queston n ths secton. You need to go back to the queston you answered Yes to and follow the nstructon gven there. I have answered No to all the questons n ths secton. You are not elgble for ths grant. Do not contnue wth ths applcaton. EMANI/APP/1516 11
Secton 6 Your resdence hstory 6.1 Tell us your address detals for the last three years before the start of the frst academc year of your course Home address If you need more space, you can attach addtonal peces of paper to ths form. Postcode From To Why were you there? Home address Postcode From To - Why were you there? - 12 EMANI/APP/1516
Secton 7 Your ndependence detals 7.1 Tck any of the followng statements that apply to you and follow the nstructons I lve under the care of the Department of Health, Socal Servces and Publc Safety or foster parent(s) I receve Income Support or ncome-related Employment and Support Allowance n my own name I am responsble for a chld If you tcked any of the above. e You need to send evdence to prove each statement tcked. Read the notes to see what you need to send. Then skp to Secton 11 to fnalse your applcaton. If you have not tcked any of the above. Go to 7.2 7.2 Do you lve apart from your parent(s)/ guardan(s)? No You are a dependent student. Your parent(s) or guardan(s) need(s) to complete the next secton. Yes You are an ndependent student. You (and your partner, f applcable) need to complete the next secton. EMANI/APP/1516 13
Secton 8 Fnancal detals Secton 8 s dvded nto four parts. Read the followng for a quck summary of each part. Part A Tell us your name and address and some other personal nformaton ncludng your Natonal Insurance number. Part B Answer every queston. Part C Only complete f nstructed. Part D Answer every queston. Who completes ths secton? Queston 7.2 told you who needs to complete ths secton of your applcaton. How to complete ths secton If you are a sngle parent/guardan of the student Enter your nformaton as Person 1, leave Person 2 blank. If there are two parents/guardans n the student s household Complete ths secton wth nformaton for both Person 1 and Person 2. If you re an ndependent student wth a partner Enter your nformaton as Person 1, your partner needs to enter ther nformaton as Person 2. If you re an ndependent student wthout a partner Enter your nformaton as Person 1, leave Person 2 blank. If you re self assessed - read page 9 of the notes for more nformaton. If you re not self assessed - you can use your P60 to complete ths secton. Data Sharng We wll share and check the detals you gve us wth HM Revenue & Customs, allowng us to gan the most accurate nformaton possble. Ths can only be done f you have a vald Natonal Insurance (NI) number. Part A 8.1 Personal detals Person 1 Frst name Person 2 Frst name Famly name Famly name Date of brth Relatonshp to student (f you re the student, wrte N/A) Date of brth Relatonshp to student Please provde your NI number below Please provde your NI number below - go to Part B - go to Part B 14 EMANI/APP/1516
Secton 8 Fnancal detals (contnued) Part B Fnancal nformaton for tax year 2013-14 How to complete Part B Answer every queston Where you answer Yes to a queston you must gve gross ncome amounts Any amounts gven must be for the tax year startng 6 Aprl 2013 and endng 5 Aprl 2014 If you leave any queston blank n Part B we wll not be able to process ths applcaton. If you don t receve a specfc type of ncome lsted n a queston, wrte n/a. Do I need to send any evdence of fnancal detals wth ths applcaton? No, you don t need to send any evdence of your fnancal detals now, but we may wrte to request ths at a later date. What f my ncome has dropped snce 2013-14? If your household ncome has permanently changed snce tax year 2013-14, read page 9 of e the notes for more nformaton. 8.2 Were you n recept of Income Support or ncome-related Employment and Support Allowance? Person 1 Tax year 2013-14 No Yes Person 2 Tax year 2013-14 No Yes 8.3 Dd you receve any ncome from salary, wages, taxable state benefts or from occupatonal or prvate pensons? No - go to 8.4 No - go to 8.4 Total ncome from salary/wages Total ncome from taxable state benefts Total ncome from occupatonal penson(s) Total ncome from prvate penson(s) EMANI/APP/1516 15
Secton 8 Fnancal detals (contnued) 8.4 Dd you receve any ncome from a state retrement penson? Total non-lump sum amount receved Total lump sum amount receved Person 1 Tax year 2013-14 No - go to 8.5 Person 2 Tax year 2013-14 No - go to 8.5 8.5 Dd you receve any ncome from savngs and nvestments? No - go to 8.6 No - go to 8.6 Total nterest from UK banks, buldng socetes and unt trusts Total ncome from UK lfe nsurance gans, securtes and partnershps Total ncome from UK nvestments and dvdends Total ncome from foregn nvestment and dvdends 8.6 Dd you receve any taxable benefts n knd? No - go to 8.7 No - go to 8.7 Total ncome from taxable benefts n knd 8.7 Dd you receve any other ncome durng tax year 2013-14 that you have not told us about n Part B? No go to Part D Yes go to Part C No go to Part D Yes go to Part C 16 EMANI/APP/1516
Secton 8 Fnancal detals (contnued) Part C Any other ncome How to complete Part C Answer every queston Where you answer Yes to a queston you must gve gross ncome amounts Any amounts gven must be for the tax year startng 6 Aprl 2013 and endng 5 Aprl 2014 If you leave any queston blank n Part C we wll not be able to process ths applcaton If you don t receve a specfc type of ncome lsted n a queston, wrte n/a. 8.8 Dd you receve any ncome from self-employment? Person 1 Tax year 2013-14 No - go to 8.9 Person 2 Tax year 2013-14 No - go to 8.9 Total taxable proft from busnesses Total taxable proft from partnershps 8.9 Dd you receve any ncome as a Mnster of relgon? No - go to 8.10 No - go to 8.10 Total taxable ncome mnus expenses that are not ncluded on your P60 or P11D 8.10 Dd you receve any other taxable ncome or lump sums? No - go to 8.11 No - go to 8.11 Total ncome receved 8.11 Dd you receve any ncome from property lettngs? No - go to 8.12 No - go to 8.12 Total ncome receved EMANI/APP/1516 17
Secton 8 Fnancal detals (contnued) 8.12 Dd you receve any ncome from UK trusts? Total ncome receved Person 1 Tax year 2013-14 No - go to 8.13 Person 2 Tax year 2013-14 No - go to 8.13 8.13 Dd you receve any foregn ncome? No - go to 8.14 No - go to 8.14 Total ncome receved 8.14 Dd you receve any ncome from an overseas penson? No - go to 8.15 No - go to 8.15 Total ncome receved 8.15 Dd you receve any other overseas ncome and gans? No - go to Part D No - go to Part D Total ncome receved go to Part D go to Part D 18 EMANI/APP/1516
Secton 8 Fnancal detals (contnued) Part D Deductons How to complete Part D Answer every queston Where you answer Yes to a queston you must gve gross deducton amounts Any amounts gven must be for the tax year startng 6 Aprl 2013 and endng 5 Aprl 2014 If you leave any queston blank n Part D we wll not be able to process ths applcaton If you don t receve a specfc type of deducton lsted n a queston, wrte n/a. 8.16 Dd you pay any prvate penson contrbutons? Total amount you pad Person 1 Tax year 2013-14 No - go to 8.17 Person 2 Tax year 2013-14 No - go to 8.17 8.17 Dd you pay any Addtonal Voluntary Contrbutons (AVCs)? Total amount you pad No - go to 8.18 No - go to 8.18 8.18 Dd you have any allowable expenses on whch you clamed tax relef? No - go to Secton 9 No - go to Secton 9 Total amount on whch you clamed tax relef go to Secton 9 go to Secton 9 EMANI/APP/1516 19
Secton 9 Your famly detals 9.1 Is your total household ncome 20,500 or less per year? No - go to 9.2 Yes - go to Secton 10 9.2 Is your household ncome 22,500 or less per year? No - The applcant s not elgble for ths allowance. Do not contnue wth ths applcaton. Yes - Are there any other young people n your household who are: under the age of 16 and qualfy for Chld Beneft or aged 16, 17, 18, 19 or 20 on 1 September 2015, are n full-tme further educaton and qualfy for Chld Beneft. No The applcant s not elgble for ths allowance. Do not contnue wth ths applcaton. Yes Go to 9.3 9.3 Gve detals of any young people n your household who are: under the age of 16 and qualfy for Chld Beneft or aged 16, 17, 18, 19 or 20 on 1 September 2015, n full-tme further educaton and qualfy for Chld Beneft. Full name Date of brth e You need to send evdence for each young person you state. Read the notes to see what you need to send. Full name If you need more space, you can attach addtonal peces of paper to ths form. Date of brth Full name Date of brth 20 EMANI/APP/1516
Secton 10 Parent(s)/guardan(s)/partner agreement How to complete ths secton If you are a sngle parent/guardan of the student Read and understand the agreement below then sgn and date as Person 1, leave Person 2 blank. If there are two parents/guardans n the student s household Read and understand the agreement below then sgn and date both Person 1 and Person 2. If you re an ndependent student wth a partner The partner needs to read and understand the agreement below then sgn and date as Person 2, leave Person 1 blank. If you re an ndependent student wthout a partner Don t complete ths secton You ve already sgned your agreement n Secton 1, contnue on to Secton 11. Parent/Guardan/Partner Agreement By sgnng ths agreement you are confrmng that: the nformaton you have gven on ths form s correct and complete to the best of your knowledge and belef; you understand that any attempt to dshonestly obtan EMA shall be treated as fraud and wll be subject to dscplnary procedures nvolvng the Polce Servce of Northern Ireland (PSNI); you have read and understood the Data Protecton statement ncluded on page 3 of the accompanyng notes; and you have read and understood these statements. Person 1 Full name (n BLOCK CAPITALS) Person 2 Full name (n BLOCK CAPITALS) Sgnature Sgnature Today s date Today s date EMANI/APP/1516 21
Secton 11 Fnalsng your applcaton! Ths must be completed by the student 11.1 Have you sgned and dated your agreement n Secton 1? No - you must sgn the agreement, we can t process your applcaton wthout t. Yes 11.2 Have you answered all the questons that apply to you? No - If you don t complete a secton or queston you ve been asked to, ths could delay your EMA payments. Yes 11.3 Dd your parent(s)/guardan(s) or your partner complete Sectons 8, 9 and 10? Remember - Secton 7 told you f you needed to do ths or not No - If you have been nstructed that these sectons are to be completed, and you forget to do ths, t wll delay any EMA payments you could get. Yes 11.4 Have you ncluded all the orgnal evdence we ve asked for? All students need to send evdence for Sectons 2 and 5, and some students wll need to send further evdence for Sectons 7 and 9. Check to make sure you have all the rght evdence to support your applcaton. No - If there s some supportng evdence you can t gve us rght now, you can send your applcaton back wthout t. Ths means we can make a start on your applcaton and we ll contact you for the evdence later but we won t be able to confrm f you can get EMA payments untl you ve sent all your evdence Yes - Read the 3 thngs to remember nformaton on the next page before returnng your applcaton form. 22 EMANI/APP/1516
3 thngs to remember 1 Get pad on tme! Send us your completed applcaton form as soon as you can and as far n advance of your course start date as possble so that there s plenty of tme for us to contact you to fnalse your EMA applcaton before you start your studes. Don t worry f you don t have all your supportng documentaton rght now, stll send us your completed form so we can start to process t. Just send n your evdence as soon as you can after ths n order to avod any delay. Make sure you send us your completed applcaton form wth all approprate evdence by 30 June 2015 at the latest f you want to have your EMA applcaton assessed and ready for the start of your course. 2 Check the postage Make sure that your completed applcaton and all evdence are weghed and the postage costs are fully pad. Remember to ask for proof of postage! 3 Send the form Return your completed form and supportng evdence to the address below: EMA Customer Servces PO Box 5591 Glasgow G52 9BJ Before you go Please complete the equal opportuntes questonnare on the back page of ths form. EMANI/APP/1516 23
Confdental Equal opportuntes questonnare In order to montor the uptake of servces provded by the Department for Employment and Learnng and the mpact of polces, applcants are requested to complete ths questonnare. Access to the answers you gve on ths questonnare wll be strctly controlled and wll not be avalable to those consderng your applcaton. Your answers wll not affect your applcaton for EMA. A What s your relgous afflaton? I am a member of the Protestant Communty I am a member of the Catholc Communty I am a member of nether the Protestant nor Catholc Communty B What s your gender? Male Female C What s your martal status? Sngle Marred Separated Dvorced Wdowed Co-habtng Other gve detals below D What s your carer status? No carng responsbltes Care for own chldren Care for other relatve Other gve detals below E Do you consder yourself to have/ have had a dsablty? No Yes gve detals below F What s your ethnc orgn? Chnese Irsh Traveller Black/Afrcan Carbbean Indan Pakstan Whte Asan other gve detals below Other gve detals below G How old are you? 16 17 18 19 24 EMANI/APP/1516