Post 16 Learner Support Fund App Form

 

STRICTLY CONFIDENTIAL

	Learner Support Fund (LSF) Application Form 2008/09

 

 

 

Please complete all details in full as your application form cannot be considered

without all the information requested.

Please read through the guidance notes before you complete this form.

 

 

SECTION 1 : STUDENT'S PERSONAL DETAILS

 

Surname:

 

Forename:

 

Address:

 

Post Code:

 

Daytime Tel No:

Evening Tel No:

 

Date of Birth:

NI No:

 

Name of School Sixth Form:

 

Name of Course Qualifications:

 

Year of Study:

 

 

SECTION 2 : PARENT/CARER DETAILS

 

Please note we ask for these details in order to certify family income.

 

Mr

Mrs

Miss

Ms

 

Surname:

 

Forename:

NI No:

 

Address: (if different from applicants' address given in Section 1):

 

 

 

Post Code:

Tel No:

 

 

SECTION 3 : ELIGIBILITY CRITERIA / DOCUMENTARY EVIDENCE

 

You are eligible for funding if any of the following applies to you.  Please tick as appropriate

(only one will be required).  Please provide evidence.

 

 

You are a dependent of someone in receipt of a means tested state benefit or Tax Credit (please enclose a current Tax Awards Notice)

 

You have a disability and/or learning difficulties and/or a health problem (please enclose details)

 

You are in receipt of an Education Maintenance Allowance (EMA) (please enclose confirmation of your eligibility for EMA for the current academic year)

 

 

 

SECTION 4 : FUNDING

 

I am requesting a financial contribution with the following costs:

 

	Amount Requested £
Special equipment or clothing for course
Compulsory course visits
Textbooks (all course textbooks and other reference materials funded by the LSF will become the property of the school’s library
TOTAL  (A maximum of £250 may be offered in any one year)

 

 

SECTION 5 : STUDENT DECLARATION

 

Please read the following:

 

The information in this form is complete and accurate, to the best of my knowledge and belief.  I will inform you immediately of any change in my circumstances at any time, which might affect my entitlement to support, for example, if I leave school or I no longer need the LSF grant I have been allocated.  I understand that if I give false information, or fail to give complete information you may prosecute me.  All monies allocated to me will be used for the purpose it is provided for.  I will return any unused money to South Gloucestershire Council immediately and provide proof of expenditure if required to do so.  Books, reference materials and non-consumable equipment funded by the LSF will be the property of the school and must be returned to the school at the end of the course.

 

Signed:

Date:

 

 

SECTION 6 : PARENT/CARER DECLARATION

 

I apply for assistance for the student named in Section 1 for expenses detailed in Section 4 in accordance with the conditions of the scheme and certify that all information given on this form is correct to the best of my knowledge.

 

Signed:

Date:

 

LSF will be reviewed on an annual basis, support is subject to funds being available at the time your application is received and assessed.  This is a limited fund and once exhausted no further funding will be available.  You should, therefore, be aware that a financial reimbursement for your expenditure is not guaranteed.

 

FRAUDULENT CLAIMS

 

This doesn’t often happen, but we must protect public funds from the possibility of fraudulent claims.  We ask for detailed information and may invite applicants for interview so we can distribute the funds fairly.  If your claim is considered fraudulent during our spot checks or auditing processes, we will request for any money awarded to you to be repaid in full.  If you fail to repay your award, we may take court action.

 

Disclaimer – all the information disclosed on these sheets is correct at the time of publication following LSC Learner Support Programme Guidance 2008/09.

 

 

SECTION 7 : SUPPORT FOR APPLICATION: LEARNER SUPPORT FUND

 

This section is to be completed in full by the Head Teacher or Head of Sixth Form

 

I support ___________________________________ (please enter students name) with their request for funding from the 2008/2009 Learning Support Fund.  I confirm to the best of my knowledge that the request for reimbursement of £_______________ (please enter amount) is reasonable, and appropriate for the course.

 

I confirm that the student is studying on a full-time course and progressing satisfactorily with his/her studies.

 

Signature of Head Teacher / Head of Sixth Form:

 

Signed:

Date:

 

Print Name:

 

 

Position:

 

 

 

When completed please return form to:

Student Access & Support Team

Department for Children and Young People

South Gloucestershire Council

Riverside Court

Bowling Hill

Chipping Sodbury

South Gloucestershire  BS37 6JX

 

 

Data Protection Act 1998:   The information that you give on this form will be used for the purpose of processing your LSF grant.  Your Local Authority (LA) is under a duty to protect the public funds it handles and may use the information you have provided on this form to prevent and detect fraud.  It may also share this information, for the same purposes, with other organisations that handle public funds.  The applicant gives the LA authority to discuss their attendance details with their school.

 

 

Learner Support Fund – Supporting learners experiencing financial difficulty