INCOME ASSESSMENT FORM 2014 -2015

RESIDENTIAL GRANT APPLICATION FORM

SECTION ONE - STUDENT DETAILS

Student Number

Mr/Mrs/Miss/Ms

Surname

Forename(s)
Home Address
Post Code:

Telephone No.

Date of Birth
Age as at 31.8.14

Marital Status / Name of School/College

Full course title
Duration of course Years
From To
Please tick as appropriate
Full Time Part Time
Please indicate where the student expects to reside during 2014/2015
Please tick as appropriate
College Accommodation
Parental Home
SECTION TWO - PARENTS’ DETAILS
Name and Address of Parents /Carers
with whom the student normally resides
Full name of Father/Stepfather Full name of Mother/Stepmother
(Delete as appropriate) (Delete as appropriate)
Address: / Address:(if different from Father/Stepfather)
Post Code: / Post Code:

Telephone No.
Occupation of Father/Stepfather Occupation of Mother/Stepmother
(Delete as appropriate) (Delete as appropriate)
Name & Address of Employer:
(During year ended 5th April 2014 / Name & Address of Employer:
(During year ended 5th April 2014)
Post Code: / Post Code:
If you had more than one employer during the tax year ended 5th April 2014, please list further details below.
Father/Stepfather Mother/Stepmother
Name & Address of Employer: / Name & Address of Employer:
Post Code: / Post Code:
SECTION THREE and FOUR
PARENTS’ INCOME AND ALLOWANCES FOR THE YEAR ENDED 5TH APRIL 2014
The following sections, 3 and 4, should be completed by the parents/step-parents of the student applying for a grant.
Please enter total gross income from all sources for the year ended 5th April 2014. It is important that under any heading where there is no income the word none is written.
Please complete Income from Benefits if either parents or step-parents have received any state benefits during the period 6/04/13to 5/04/14.
SECTION THREE - INCOME DETAILS
Income source / Examples / Father / Mother
Gross Taxable Salary * / P60 2013/2014 or March payslip 31/03/14.
Business Profits Sole Trader * / See notes and guidance after Section 6
Business Profits Partnership * / See notes and guidance after Section 6
Directors Fees * / See notes and guidance after Section 6
Taxable Benefits, e.g. Car, BUPA, etc. * / P11D 2013/2014 or P2 2013/2014
Spare time and casual work * / See notes and guidance after Section 6
Pensions - Please give details of each pension * / P60 2013/2014 or letter from Job Centre Plus
Income from Property or letting rooms * / See notes and guidance after Section 6
Bank or Building Society interest on deposits / Please indicate whether you have entered a gross or net figure
Investment/Annuities etc. / Please enter gross amount including tax credits
Any other income
SECTION THREE - INCOME FROM BENEFITS
Please enter details of all benefits you received, except Child Benefit. Please enter the amount you received during the 2013/2014 tax year not the amount you receive weekly, fortnightly or monthly.
Benefit / Father / Mother
Income Support*
Tax Credits*
Job Seekers Allowance*
Housing Benefit*
Care Allowance*
Disability Living Allowance*
Other*
Please state
Evidence of Income and Benefits received
PLEASE ENSURE THATIN ALL CASES WHERE THERE IS AN ASTERISK (*) DOCUMENTARY EVIDENCE IS SUBMITTED. ALL DOCUMENTATION SHOULD BE PHOTOCOPIED CLEARLY.
IF YOU ARE UNABLE TO PROVIDE EVIDENCE OF YOUR INCOME THEN YOUR ASSESSMENT WILL BE MARKED AS PROVISIONALONLY. WE WILL REQUIRE THIS INFORMATION SENDING TO US BY THE START OF THE TERM IN SEPTEMBER AND IF IT IS NOT RECEIVED IT MAY RESULT IN THE PAYMENT OF THE STUDENT’S GRANT BEING WITHELD.
If you have declared income from benefits please provide either a letter confirming the amount you have received from Job Centre Plus, or from whoever pays the benefit to you, or ask them to complete the enclosed form.
SECTION FOUR - ALLOWANCES
Please enter allowances relating to the year ended 5th April 2014.
Allowances / Example of Evidence / Father / Mother
Retirement Annuities/Personal Pensions *
Do not enter company pensions / Photocopy of original policy or annual statement
Please give details of any dependant children other than the student, including those who will be at school, college or university between 01/09/14 and 31/08/15. Please include letter of confirmation for student loan or University place. Allowance will be given.
Name / Date of Birth / School/College to be attended 1/9/14 to 31/08/15 / Details of any education award granted
SECTION FIVE
STUDENT’S DECLARATION
PLEASE READ THIS SECTION CAREFULLY AND SIGN THE FOLLOWING
This information supplied by me to the best of my knowledge is correct and complete. I undertake to inform the Local Education Authority immediately of any changes in my financial circumstances or of any alterations in the particulars given and to supply any additional information which may be required to verify the facts stated. If a change in my circumstances results in a revised financial award for the academic year then I undertake to repay any amounts overpaid to me back to the Authority.

Signature of Student Date
SECTION FIVE CONTINUED
PARENTS’ DECLARATION
PLEASE READ THIS SECTION CAREFULLY AND SIGN THE FOLLOWING
This information supplied by me to the best of my knowledge is correct and complete. I undertake to inform the Local Education Authority immediately of any changes in my financial circumstances or of any alterations in the particulars given and to supply any additional information which may be required to verify the facts stated.

Signature of parent/ step parent/carer(s) Date

DATA PROTECTION ACT 1998 - The information provided will be used to determine whether financial assistance will be awarded. North Yorkshire County Council may make enquiries about the validity of the information provided from other central and / or local government bodies, as deemed appropriate by the County Council. The County Council has a duty to protect public funds it administers and to this end may use the information provided on this form within the County Council for the prevention and detection of fraud. It may also share this information with other bodies solely for the purpose of administering public funds.
ACCOUNTANT’S DECLARATION
Only have this section completed if this form has been completed by your accountant.
Are the figures declared final figures as submitted to the Inland Revenue for the tax year 2014/2015?

YES NO
Signature of Accountant

Date

SECTION SIX
Checklist

  1. Have sections 1-4 been completed fully?
  1. Have the declarations at section 5 been signed as necessary?
  1. Is all the relevant photocopied documentary evidence attached?
Please return your completed form and documents to:
Student Support Services
AskhamBryanCollege
Askham Bryan
York
YO23 3FR
If you need to contact us please call us on telephone number:
01904 772201 / 01904 772222
9.00am to 5pm Monday to Thursday
9.00am to 4.30pm Friday
NOTES AND GUIDANCE
SECTION THREE.
Salary details should be parent’s total taxable pay for the year ended 31st March 2014 as shown on your March payslip. Please remember to enclose copies of payslips dated 31st March 2014 or Form P60 for 2013/2014 as evidence.
Business Profits –if parents are self employed or in a partnership you need to provide details of net profits for the year end 5th April 2014. If you are unable to provide the exact figures at present you should enter an estimated figure on the form so that a provisional assessment of grant can be made. You will be required to confirm the figures which you have submitted to the Inland Revenue for the year ended 5th April 2014 before the beginning of the term in September 2014.
Director’s Fees or salaries received by either parent as a director of his/her own or any other company should be entered here. If this figure is estimated a form will be sent to you in due course and you will be required to confirm the figures which you have submitted to the Inland Revenue for the year ended 5th April 2014.
Taxable Benefits include Car and Fuel benefit, BUPA subscriptions etc. received in the course of employment. Please enclose a P11D for 2013/2014 or P2 for 2013 /2014.
Pensions include all taxable pensions such as State Retirement Pensions, Widow’s Pensions and pensions from employers. A form P60 2013 /2014 or a letter from Job Centre Plus should be enclosed as evidence. Pensions from employers for dependent children should also be entered here unless that pension id paid direct to the child.
Income from Property/Letting/Accommodation can be estimated if the exact figures are not yet available.
Bank or Building Society interest earned on deposits should be entered as a gross amount for the year ended 5th April 2014.
Investments which have paid dividends during the year ended 5th April 2014 please enter the amounts here, including tax credits.
SECTION FOUR
Retirement Annuities or Personal Pensions can only include private or personal pension premiums only. Do not enter Superannuation contributions made through your employment. Please send copies of the policies as evidence.
THE AUTHORITY RESERVES THE RIGHT TO REQUEST DOCUMENTARY EVIDENCE WHICH HAS NOT BEEN REQUIRED PREVIOUSLY, SHOULD IT BE CONSIDERED NECESSARY.