Unite Foundation Scholarship Scheme

Application for Academic Year 2017/18

Please ensure that you have answered every question and enclosed relevant evidence to demonstrate your eligibility for this bursary (e.g., a letter from your personal advisor/support worker/teacher, evidence that you have applied for the maximum Student Finance England/Student Finance Wales funding available to you for 2017/18 and, if receiving additional financial support from your Local Authority or other source, a letter from them showing the intended level and duration of funding). If you do not provide these your bursary application will be delayed.

Part 1: Your personal details
Full Name
Previously used first and/or last names / Gender
Home Address
Postcode / Contact Tel:
Email address
Date of Birth / Age
Part 2: Intended course for 2017-18
Intended course of study / UCAS course code
Qualification (e.g. BA, BSc) / Length of course (years) / 1 2 3 4 5
Full time/Part time / Full time/ Part time / Year 0 or year 1? / Is this your first time at University? / Yes/ No
If this is not your first time at University, please give brief details of your previous course, including the date and reason for leaving below.
Part 3: Your eligibility
Have you spent time in Local Authority care? / Yes / No / Total length of time spent in Local Authority care (if applicable)?
Were you in Local Authority care on or around your 16th birthday? / Yes / No / Will your Local Authority be supporting you financially at University? / Yes / No
If yes, how much?
Are you living in a Foyer property or other supported lodgings scheme? / Yes / No / Please give the name of the Foyer property/other scheme and the Manager
Are you irreconcilably estranged from your parents? / Yes / No / If yes, who do you normally live with?
Have you been adopted? / Yes / No / Are you likely to leave Unite halls & stay elsewhere during vacation periods? If so, who with?
Have you had confirmation from Student Finance England or Student Finance Wales that they recognise and have assessed you as irreconcilably estranged from your parents for loan and grant purposes? / Yes/No
Do you have a Social Worker / Personal Advisor / Support Worker/Local Authority?
If so, please provide their name, email & phone details below: / Yes/ No
Part 4: Disability/special medical needs
Do you have a disability or medical condition? / Yes/
No / If yes, have you applied for the Disabled Students Allowance? / Yes/
No
Does your disability/ medical condition incur extra cost? / Yes/
No / Do you have any special access needs? / Yes/
No
If yes to any of the above, please give details below:
Part 5: Financial details
How much are your tuition fees for 2017-18 / £ / Have you/will you apply for the full means tested part of the student maintenance loan? / Yes/
No
Please indicate how your fees are being paid & in what proportion / SLC Fee loan - £ NHS Bursary - £
Parent/guardian - £ Self - £
Partner/spouse - £ Other - £
Please specify ‘other’ source here –
Have you applied to live in Halls of Residence in 2017-18? / Yes/
No / Have you given consent to Student Finance England (SFE) to share financial information with Plymouth University? / Yes/
No
Part 6: Additional information – please provide us with some detail about you
What are your current circumstances?
Why are you applying for this scheme?
How would this make a difference to your time at university?
Part 7: Declaration
-  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 disciplinary action may ensue.
-  I understand that my name and course of study may be passed to the Unite Foundation on request in order to process my application.
-  I understand that applications are seen only by the Plymouth University Scholarship Committee and the Unite Foundation trustees for the purpose of processing my application and monitoring and evaluating the effectiveness of the scheme. It may be necessary for supporting information to be sought from other university staff or other sources in order for the Plymouth University Scholarship Committee to reach a decision on my application.
-  I agree to Plymouth University undertaking such checks as it thinks fit to verify any information provided by me or on my behalf.
-  I have enclosed relevant evidence to demonstrate my eligibility for this scholarship (e.g., a letter from my personal advisor/support worker/teacher, evidence that I have applied for the maximum Student Finance England/Student Finance Wales funding available to me for 2017/18 and, if receiving additional financial support from my Local Authority or other source, a letter from them showing the intended level and duration of funding).
Signature / Date

Please return this form and supporting evidence, by email to or by post to Care Leavers Service, 4 Portland Mews, Plymouth University, Drake Circus, Plymouth,

PL4 8AA. If by post, please provide photocopies, not original documents.