Or a Young Person in Direct Receipt of Income Support in Your Own Right

Or a Young Person in Direct Receipt of Income Support in Your Own Right

Bursary Application Form
For students aged 16 -19
Academic Year 2017/ 2018 / winstanleycollege
The Student Bursary is to assist students on a low income manage the costs of studying and is categorised as follows
A - Guaranteed Bursary
to be eligible you should be either
  • a young person in care,
  • or a care leaver,
  • or a young person in direct receipt of income support in your own right,
  • or a disabled student in receipt of employment support plus disability living allowance,
Or
B - Discretionary Bursary
If your household is receiving benefits or the household income is less than £16,190 you may be eligible to a weekly bursary payment (amount to be confirmed) over 38 weeks, or you may be issued with a transport pass if you use our private transport to travel to college. Proof of your household income is required.
These payments will be dependent on good attendance, satisfactory academic progress and it is subject to the number of applications received and the funds being available.
Free College Meals
To be eligible for free college meals you must be aged 16-19 and you or your parent or guardian must receive one of these benefits:-
  • Income Support
  • Income based Jobseekers Allowance
  • Income related Employment & Support Allowance (ESA)
  • Support under part VI of the Immigration and Asylum Act 1999
  • The guarantee element of the State Pension Credit
  • Child Tax Credit (provided you are not entitled to Working Tax Credit) and have annual gross income of no more than £16,190 as assessed by HMRC.
Your application will automatically be assessed for both free college meals and the 16-19 bursary fund.
Complete this form in BLACK INK and in BLOCK CAPITALS.
Answer all of the questions required – enter N/A, NO or NIL where appropriate.
Make sure you sign and date the application on the back page.
Section 1 – About the other people living in your home
You should live at the same address as the person providing the evidence and be named on award notices
Family NameFirst NamesRelationship to you




Section 2 – Household Income – Completed by Parent(s)
Please enter / Parent 1 / Parent 2
Employment income
please provide copy of P60 to April 2015
Working Tax credit
please provide copy of evidence - April 2015 award
please note we requireall of the pages
Self-employment income please provide copy of evidence
Pension income please provide copy of evidence
Benefits receiving – please specify
………………………………………………………………
please provide copy of evidence

Section 3 – Student Details Student ID (if a new student DOB)

Surname name

First name
Date of birth☐☐/☐☐/☐☐
Home address
Residency Questions

What is your nationality?
Have you lived in the UK for the 3 years preceding the first day of your course? Yes☐No☐
Do you receive a wage for any part time work?Yes☐No☐
Section 4 - Your Payment Details
  • Complete ALL the boxes below
  • We will pay directly to you into your Bank account.
  • Make sure your account can accept BACS Direct Credits. You can check this with your Bank / Building Society.

Bank Name (e.g. Barclays)

Branch Location (e.g. Wigan, Market Street)

Name of Account Holder (e.g. Mr A Nother)
Sort Code ☐☐-☐☐-☐☐
Account Number ☐☐☐☐☐☐☐☐
Section 5 – Winstanley College Coach/Bus Service (private transport)
I will be using the College private transport Coach/Bus Service Yes/No
I have returned the ‘Letter of Intent’ for Private Transport Yes/No

Please indicate the bus number
Please note: if you are awarded a bus permit as your bursary award you will not receive a weekly payment as well.
Don’t forget to sign the applicationover the page
Section 6 – Student and Parent(s)/Carer(s) Declaration
The declaration below must be signed by student and by the Parent(s) / Carer
I / we certify that the information given is, to the best of my / our knowledge and belief, correct. I / we will inform the college of any change in circumstances and I / we understand that money may be claimed back if information provided is known to be false.
Student signature / Date
Parent(s) / Carer signature / Date
When you have completed this form you should send it with the evidence required, (please do not send originals) to
Bursary Fund Administrator,
Finance Department,
Winstanley College,
Winstanley Road,
Billinge, Wigan
WN5 7XF
Alternatively the completed forms and copies of evidence can be handed into main reception at College marked for the attention of the Bursary administrator.
Any queries please email:
Please note : Applications will not be considered without copies of the appropriate evidence
Confidentiality: Applications are only seen by staff involved in the delivery of the Bursary Fund.
Data Protection Act 1998: The data requested on this form and any other supporting information is covered under the notification provided by the college under the Data Protection Act. Personal Data will be used solely for the purposes related to your application for financial support.
The data you provide will not be passed to any other third party without your prior consent, except where the college is required to do so by law.
For office use only
Approved By Date

Bursary Application Form 2017-2018

Top View