16 / EU ALF / / Date of receipt
/ /
EUStudent Hardship Application
2016/2017
IMPORTANT – please read before applying:
Apply on this form if you are a full timeundergraduate student from an EU or EEA country, and have applied to Student Finance England for a tuition fee loan.
NHS funded students, part time students & Partner College students are not eligible.
Please note if you are an EEA Migrant Worker, you should be eligible for FULL UK Student Support & can apply to the Financial Support Fund instead.
It is expected that any EU/EEA student starting a course at Plymouth University will have a basic source of income such as earnings, savings or financial support from their own government.
This fund is a source of discretionary assistance for EU students who can show they need exceptional extra support on top of their normal source of income, or who are in an emergency situation because their normal source of funding is delayed or interrupted.
Applicants must provide photocopies of the following documents to support their application:
Essential:
Student Registration Card
Evidence ofSFE EU Tuition Fee Loan
Fullcurrent bank statements for all accounts x3 months. Balance slips are not acceptable.
Evidence of accommodation costs – Tenancy agreement or mortgage statement
Evidence that you have been looking for employment
If applicable:
Evidence of other loans / funding / credit cards
Evidence of other income (including partner’s income) e.g. wage slips
Evidence of travel costs
Evidence of childcare costs/child maintenance payments
Evidence of compulsory field trip costs you contribute
PLEASE RETURN YOUR COMPLETED FORM TO ; STUDENT FUNDING UNIT, NAB FLOOR 4, UNIVERSITY OF PLYMOUTH, DRAKE CIRCUS, PLYMOUTH, PL4 8AA
INCOMPLETE FORMS OR APPLICATIONS WITHOUT THE RELEVANT SUPPORTING EVIDENCE WILL NOT BE PROCESSED
Part 1: Your Personal Details
1 Student Registration Number
2 Your title / Mr / Mrs / Miss / Ms
3 Your first names (in full)
4 Your surname
5 Your gender / Male / Female
6 Your date of birth (DD/MM/YYYY) / / /
7 Your UK postal address
(We will contact you in writingvia your student email account within 28 days)
Postcode
8 E-mail address
9 Contact telephone number
10 What is your Nationality?
Personal status/Accommodation details /
11 Do you live: / alone? / withyour partner or spouse?
in shared accommodation? / with your parents or guardian?
How many other adults live at this address?
Do you share all household expenses? / Yes / No
Do you maintain two homes? / Yes / No

12 If ‘Yes’, where is the other maintained home?
Part 2: Course Details
13 Course title
14 Faculty/Department
15 Are you / Undergraduate
16 Are you studying: / Fulltime?
17 What date did you START your course (DD/MM/YYYY)? / / /
18 current year of course / 1 / 2 / 3 / 4 / 5
19 Is this a repeat year? / Yes / No
20 Is this your final year? / Yes / No
21 Have you been on a previous HE course? / Yes / No
If YES, what was it and where?
22 Is this a placement year? / Yes / No
If YES, is it a paid placement? / Yes / No
Part 3: Your Dependants
23 Do you have a partner? / Yes / No
24 If YES, is your partner financially dependant on you? / Yes / No
25 Is your partner a student, if so, where?
26 Do you have any children living with you?
Yes – give details / Full Name/s: / Date/s of birth:
No
27 Do you have any children who live elsewhere but are financially dependent on you?
Yes – give details / Full Name/s: / Date/s of birth:
No
Part 4: Disability/Special Medical Needs
28 Do you have a disability or chronic medical condition? / Yes / No
If yes, please give details below:
(If you need to, feel free to continue on a separate sheet and attach it to this form).
Part 5: Bank/Building Society/Credit Card Details
You MUSTgive details of ALL working Accounts:
Bank/Building Society/
Credit Card / Current Balance / Overdraft/Credit Limit
£ / £
£ / £
£ / £
Part 6: Supporting Statement
29 Have you made any previous applications to this fund? If so, please provide details.

30 Do you have any outstanding Short-Term Loans / Debts with the Funding Unit
or Plymouth University?
If so, please provide details.

All EU students are expected to have arranged for a basic source of income before taking up a University place, such as earnings, savings, Government support etc…
All applications are assessed individually & there is NO guarantee of payment.
You must state here why you are in financial difficulty and why you believe your situation to beexceptional and to merit additional support.
If your statement does not fully explain this, you may be called in for an Interview.

Part 7: Payment by BACS

If your application is successful, any award is usually paid directly into your bank or building society account.

If you are unable to be paid by BACS, please tick this box:
Please provide the following information:
Student Registration Number
Your Full Legal Name
Bank/Building Society Name
Account Number /
Sort Code /
Type of Account (e.g. current / Student etc)
Account Holder’s Name
Your Email Address & Contact Telephone Number
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Part 8: Income Part 9: Expenditure

£ per annum / £ per month
Tuition fee Loan / Rent / Mortgage
Maintenance Loan / Rent / Mortgage Arrears
Bursary or Scholarship from Plymouth University / Gas
Electricity
Maintenance Grants
(please specify) / Telephone
Course Costs
Grant or Allowance from Home Country / Food
Parental Help / Household / Laundry
TV Licence
Student’s
Earnings / Wages / Buildings / Contents Insurance
Other Insurances
Partner’s Earnings / Childcare Costs
Disability Benefits / Grants / Travel Costs if not within walking distance
State Benefits
(please specify) / Travel home each term if applicable
Disability Costs
Other Income / Savings
(please specify) / Medication costs (specify)
Child Maintenance Support
Other Costs (please specify)
TOTAL PER ANNUM: / £
One –off costs
(e.g. Fieldtrips)
TOTAL PER MONTH: / £

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Part 10: Confidentiality
Applications are seen only by Student Funding staff. It may be necessary for additional supporting information to be sought from other university staff in order to reach a decision.
Plymouth University is a data controller in terms of the 1998 legislation. The Student Funding Unit follows University policy in matters of data protection. The data requested in this form is covered by the notification provided by the University under the Data Protection Act. Personal data will be used solely in the department for statistical purposes and electronic record keeping. The data will not be passed to any other third party without your consent, except when the University is required to do so by law. Any formal enquiries concerning the use of data noted here should be addressed to the Head of Student Funding.
Part 11: Declarations
I certify that to the best of my knowledge, I fulfil the following criteria:(please tick relevant boxes)
I am an EU National
I have applied for a Tuition Fee Loan from the Student Loans Company
AND
I confirm that I am supporting the children named in Part 3
I confirm that I am not living with a spouse/partner (if applicable)
I confirm that I am registered and in attendance on the course described on page 2
I declare that the information that I have given on this form is correct and complete to the best of my knowledge. I understand that giving false information will automatically disqualify my application and may also lead to disciplinary procedures resulting in possible expulsion from the university. For example, failing to declare a partner with income or failing to declare a working bank account. I further undertake to repay any grants obtained by me as a result. I understand that if I leave my course before the end of the year I may have to repay all or part of any money allocated to me from the EU Hardship Fund.
Print your name / Your signature / Date

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