16-19 Bursary Application

For the Academic Year 2017-2018

B1 Mark one of the following boxes:

I am/we are the adults applying for the Bursary on behalf of a student

I am the young person applying for the Bursary

All students MUST complete sections B9 & B10

To be completed by the adult(s) who are mainly responsible for the young person; or by the young

person if the criteria in category 1 of the introduction applies to them.

Young Person details

Surname: First name:

Date of Birth: Form:

Complete B2, 3, 6, 7 & 8

Complete B4, 5, 6, 7 & 8

Both adults 1 & 2 MUST complete the form unless single parent/carer household

B2 Adult 1 Adult 2

a. Title/Surname/Family name

b. First names:

c. National Insurance Number:

d. Relationship to Young person:

e. Does the young person Yes No Yes No

named above live with you?

f. Contact Telephone Number

g. Contact Address

h. Email Address

i. Are you currently on

income support or other Yes No Yes No

means tested benefit?

j. Is your total family income less than £23,000 for the last tax year? Yes No

k. Was your Son/Daughter eligible for free school meals in year 11? Yes No

l. Has your son/daughter applied for a 16+ Travel Card Yes No

m. How does your Son/Daughter get to school? Bus Car Train Walk

Supporting Documents will be required for answers to this section.

Continue to section……. B3 & B6

B4 (To be completed by the student)

a. Surname/Family name

b. First names

c. Date of birth

d. Form Group

Continue to section B5 & B6

B3 Adult 1 Adult 2

a. Do you currently meet UK

residency conditions? Yes No Yes No

Supporting Documents will be required.

B5 (To be completed by the student)

a. Are you in Local Authority care? Yes No

If yes supporting documents will be required

b. Are you living with Foster

Parents? Yes No

If yes supporting documents will be required

c. Are you a Care leaver Yes No

If yes supporting documents will be required

d. If you are not living with adults who are

mainly responsible for you and you are

not in care do you currently receive

income support? Yes No

If yes supporting documents will be required

e. Are you a disabled student who receives employment support allowance and or disability

living allowance? Yes No

If yes supporting documents will be required

B6 Supporting Documents-

Passports, Proof of Benefits, All pages of the Tax Credit Awards if eligible.

Please list all documents you have included in support of your application

Continue to section B7 & B8

B7 - Residency Conditions

To qualify for a 16-19 Bursary Grant you must meet the residency conditions set out below. Read

the notes carefully and then mark one box only for the condition which applies to you below. If

you require further information about residency, please contact the Attendance Officer in school.

A I am a British Citizen and have lived in the UK for at least three years prior to the start of the

learning programme.

B I am the young person who has ‘settled status’* and have been ordinarily resident in the UK

for at least three years prior to the start of your learning programme.

*’Settled status’ means having either indefinite leave to enter or remain (ILE/R) or having the right

of abode in the UK.

British citizens and certain other people have the right of abode in the UK:

those with European Community – United Kingdom of Great Britain and Northern Ireland Passports

British Dependent Territory Citizens (now known as British Overseas Territory Citizens)

Those whose passports have been endorsed to show they have Right of Abode in the UK

Those who have a certificate of naturalisation or registration as a British Citizen.

C I am a national of any European Union (EU) country (including Gibraltar) or the spouse or

civil partner or child of an EU national, and have been ordinarily resident in the European Economic

Area (EEA) or Switzerland for at least the three years prior to the start of learning programme.

D I am:

an EEA migrant worker with the right to work in the UK, or the spouse, civil partner or child of an EEA migrant worker, who is ordinarily resident in the UK at the start of the learning programme and have been ordinarily resident in the EEA, or Switzerland, throughout the three year period prior to that; or the child of a Swiss national who is ordinarily resident in the UK at the start of your learning programme, and have been ordinarily resident in the EEA or Switzerland for the three years prior to that; or the child of a Turkish migrant worker who has the right to work in the UK, and who is

ordinarily resident in the UK at the start of your learning programme, and have been

ordinarily resident in the EEA, Switzerland or Turkey for the three year period prior to that.

E I am recognised as a refugee by the UK Government, or you are the spouse or civil partner

or child of a refugee, have been granted Humanitarian Protection, or have EU Temporary

Protection.

IMIMPORTANT:- if you do not meet these conditions, DO NOT apply for a 16-19 Bursary Please call us

on 01622 623922 and ask for the Attendance Officer for more help on residency Conditions.

EEA Countries

The European Economic Area brings together the twenty seven EU Members** and the three

European Free Trade Association countries. The EEA countries are as follows:

Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany,

Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta,

Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden and the United

Kingdom.**Gibraltar is a member of the EU and is therefore considered part of the EEA.

B8 – Declaration

I/We declare that all information given in support of this application is correct and complete

to the best of my/our knowledge and belief.

False or incomplete information may result in payments being withheld or withdrawn and or

action taken to recover any payments already made.

I/We understand that:

I/We share responsibility for the information given with any partner named on this

form

If the young person applying for the 16-19 Bursary does not keep to their school

agreement, or they leave school, they will not be eligible to receive further payments.

The young person is eligible for a 16-19 Bursary on residency grounds and can provide

suitable evidence as proof.

I/We must inform the school should my/our residency or financial situation change.

Please ensure you have enclosed copies of supporting documents. Applications cannot be

processed without them.

Adult 1

Signature: Date:

Print

Name:

Adult 2

Signature: Date:

Print

Name:

Student

Signature: Date:

Print

Name:

Warning:

Knowingly making a false or inaccurate declaration may leave you liable to prosecution. Obtaining

money by deception is a criminal offence punishable in law.

Maidstone Grammar School reserves the right to refuse or withdraw a 16-19 Bursary in the event

that information completed on this form is found to be false or inaccurate. You have a right to

appeal the denial of a bursary and in the event of this happening should write to the Chair of

Governors at the school stating your reasons for the appeal to be heard.

B9

Maidstone Grammar School

16 – 19 Bursary Fund Agreement

In order for my 16 – 19 Bursary Fund payment to be authorised each term I will

comply with the following conditions:

I will attend every lesson and registration.

I will be on time for all lessons and registrations.

Contact will be made to the absence line 01622 623922 on the 1st day of

absence.

MGS Extraordinary Leave of Absence forms must be completed two weeks

prior to University visits/Driving test etc.

All medical appointments must be confirmed with a letter from a

Parent/Carer or Medical appointment card.

I understand that if I am late more than twice in one week it may stop that

terms payment.

I will look at my school email/VLE every week to check any messages from

the Attendance Officer and act upon the message accordingly.

Student: I have read and understood the conditions of this Learning Agreement

and will work towards successful completion of my course. If any of my

circumstances change I will notify the Attendance Officer.

Student Signature: Date:

Print Name:

B10 – Bank Details Form

To be completed by student

Please complete the following information carefully. Incorrect information will result in a delay in

payment.

If you have any queries please contact the Bursary on 01622 752101 or email Bursary@mgs-

kent.org.uk

YOUR NAME:

YOUR TELEPHONE NUMBER:

NAME AND ADDRESS OF BANK OR BUILDING SOCIETY:

NAME OF ACCOUNT HOLDER:

BANK SORT CODE:

- -

BANK ACCOUNT NUMBER:

BUILDING SOCIETY ROLL NUMBER (If Applicable):

B11 – office use only

Date Application received:

Name of officer processing:

Application processing deadline:

Supporting documentation received? Yes No

List all supporting documents received from applicant:

Copies taken and originals returned to applicant Yes No

Application processed to decision board for consideration Date:

Application outcome: Approved Cat 1 Disallowed

Cat 2

Cat 3 Amount

Notes re allocation/

refusal:

Approved applications should be sent a payment information collection form, and asked to

return it to the Bursary for processing.

Date application responded to:

Date Signed agreement received:

Notes:

For office use only