CONFIDENTIAL

Application for Childcare Support 2016/17

The Discretionary Bursary offers financial support for childcare to learners who are over 20* years of age, and in full time or part time Further Education at Askham Bryan College and Newton Rigg..
If you are studying a “Full Cost” course such as a Work-Based Learning course, or a Higher Education course you will not be eligible for any support via this fund.
*Learners under 20 should apply for Care to Learn to help with childcare costs, please contact Student Services for more information.
Please complete this form in block capital letters and make sure you answer all the questions.
If you need help in completing this form, or require the form in an alternative format, please contact Student Services on 01904 772201 or 01904 772271.
Please provide evidence of current income and/or benefits. Failure to provide this will delay your application.
1)Learner Details
Please provide your personal details.
Student Ref. number:
Title:
Surname:
First Name(s):
Date of Birth: //
Age: / Address:
Postcode:
Telephone:
Mobile:
Email: /
2)Course Details
Please give as much information as you can about the course(s) you are currently taking.
Are you: / Full-time? / Part-time?(Please tick)
Course Title / Start Date
//
3)Household Members
Please give details of all other members of your household including any partner/ spouse and children.
Name / Age / Relationship To Learner / Financially dependent upon Learner?
Yes No
Yes No
Yes No
Yes No
Yes No
4) Childcare Details
Childcare funding will only be allocated for your current course. A new application will be necessary for progression/additional courses. If you are on a course of more than one year’s duration and require funding for subsequent years, you will need to reapply at the start of the next academic year.
Date you wish your childcare place to start://
5) Child Details
Please give details of the dependent children you require childcare / financial support for
Name / Date of birth / Details of childcare required / Are you applying for childcare for this child?
Yes No
Yes No
Yes No
Yes No
--
6) Details of registered childcare provider:
Name of Provider: / :
Address: / :
:
Telephone number: / :
Registration number: / :
* Please note that a photocopy of the childcare provider’s registration certificate must be provided.
Times when childcare will be required ()
Monday / Tuesday / Wednesday / Thursday / Friday
AM
PM
Childcare cost per week:
7) Declaration
  • I confirm that I am not on a Work-Based Learning or Higher Educationcourse.
  • I confirm that neither I nor my partner is in receipt of the childcare element of Working Tax Credits.
  • I agree to notify the College of any change in my circumstances which may affect my eligibility for funding, or of any change to my course, as soon as either of these occurs.I understand that failure to do this may mean that the College will recover the cost of childcare from me.
  • I confirm that I, nor my partner are in receipt of any childcare vouchers / work related childcare support schemes
  • I understand that I am required to pay towards the cost of childcare and failure to pay this contribution will result in the college funding being withdrawn.
  • I understand that the College may claim back all or some of the award made to me if I have given misleading or inaccurate information intentionally. I recognise that false statements can leave me open to prosecution.
  • I understand that financial assistance is dependent upon satisfactory attendance, or I withdraw from my course early, I may be asked to pay back some or all of my childcare costs received to that date.
  • I understand that any funding I am allocated is for my current course only and that a new application will be required for progression/additional courses.
  • I understand that the College pays 80% of the childcare costs during term-time only.

Signed:
(learner applying for assistance) / Date: //
8) Evidence we need to see
The Government gives Learner Support Funds to us from taxpayers’ money, so we require evidence that you meet all requirements before we can make an award. All evidence provided will be treated in the strictest confidence. You must provide evidence of your household income. If you live independently you must provide evidence of your income, if you live with a partner or spouse you must provide evidence of their income also. The evidence we can accept is as follows:
Financial Evidence
Form TC602 from Inland Revenue for Tax Credit awards dated April 2016.
Photocopies of latest 5 (weekly) or 2 (monthly) payslips
or
A letter from current employer as proof of wage
P60 issued by current employer dated April 2016
or
Details of accounts for self-employment for 2015/2016
Please provide the aboveevidence to support your application, if you are unsure what evidence to send or have any queries regarding the application form please contact Student Services for advice on 01904 772201 or 01904 772271.
Failure to provide evidence will delay your application and may result in loss of funding.
What Happens Next?
Please return your application form to:Student Services, Askham Bryan College,
Askham Bryan, York, YO23 3FR.

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