Post on 08-Jul-2020
1SFW/PTG1F/1314
Your forename(s) Your surname
Customer Reference Number (if you have one)
The answers you give on this form will help us decide whether you are eligible to receivea grant and if so how much you are entitled to under the Education (Student Support)(Wales) Regulations 2012 (as amended).
This form should be completed in conjunction with the PTG1 notes. The notes will give you extrainformation to help you complete the form correctly so that there are no delays with processingyour application due to incorrect answers, missing information or lack of evidence.
Please refer to the guidance notes when you see this icon
Please supply evidence when you see this icon
Disabled Students’ Allowances (DSAs)If you want to apply for DSAs you need to complete this form then complete a disabled Students’Allowances (DSA) application form. Please send me a DSA form
Have you received grants or Disabled Students’ Allowancesfor this programme of study before? Yes No
Childcare GrantDo you want to apply for a Childcare Grant? Yes No
Deadline – You can apply for a part-time grant at any time in the academic year provided youare within the time limit. The time limit for applying is usually nine months from the start of theacademic year.
Application forgrants for part-time study2013/14
This form is also available fromwww.studentfinancewales.co.uk
PTG1
SFW/PTG1F/13142
What sections do I need to complete?All students need to complete
sections 1, 2, 4, 5, 7, 8 & 9and the declaration
Applying for part-time Student Finance
I am applying for the first time, do Ineed to complete anything else?
Yes, you also need to completesection 3
Does my university/college need tocomplete anything?
Yes, they need to complete section 6
Where do I return my application?You should return it to your local authority(LA) at the address shown on the back of
this form, the accompanying letter withthis form or on the contact list available
online atwww.studentfinancewales.co.uk
Who should complete this form?New and returning part-time students,returning full-time distance learners*
* If you study full-time you should only complete this form if you are studyingthrough distance learning by choice and not because you have a disabilitywhich prevents you from attending your university/college in person.
SFW/PTG1F/1314 3
a
personal details 1section
Title Mr Mrs Miss Ms
Forename(s)
SurnameSex Male Female
Date of birthPlease complete these questions with the details exactly as stated on your birth certificate or passport.
Place of birth (the name of the town or village)
Nationality
Marital status
Please tick one box:SingleLiving with a partnerMarried/civil partnership Please give the date of marriage/civil partnership.SeparatedDivorced/dissolved civil partnershipWidowed/surviving civil partner
Will you be 25 or over on the first day of the academic year? Yes No
YEARMONTHDAY
YEARMONTHDAY
Please give your current home address. Please also give your term-time address if youknow it.
Home address
PostcodeHome phone number
Term-time address
PostcodeDate on which you will move to this address
Mobile phone number
Email address
YEARMONTHDAY
Contact status
b1
c
b2
SFW/PTG1F/13144
Will you be getting funding from any other source to meet the costsof your course in 2013/14? Yes No
Have you received a grant for part-time study for this programme ofstudy for any academic year up to and including 2012/13? Yes No
Do you hold a first degree from an educational institution in the UK? Yes No
Have you ever had any other loans from the Student Loans Company (SLC)? Yes No
If ‘Yes’, are you behind with the repayments? Yes No
Did you receive any loans from the Student Loans Company (SLC) when you were under 18? Yes No
If ‘Yes’, have you signed credit agreements for all of them? Yes No
a
if No go to section 3
b
c
d
e
if Yes go to section 4
If ‘Yes’, please givedetails of this funding.
previous loans or financial support2section
SFW/PTG1F/1314 5
a1 Are you a UK national?
a2 Are you an EU national?
a3 Are you the child of a Swiss national?
a4 Will your Swiss national parent be living in the UK on the first day of the academic year?
section
3residence
If Yes go to b1
Please do not complete this section if you have previously applied forstudent finance for this programme of study.
Yes No
go to section 4
If No go to a5
Yes No
Yes No
a5 Are you or your:• husband, wife, civil partner; or• parent(s), a step-parent; or• child, son or daughter-in-law, child’s civil partnera European Economic Area (EEA) national or Swiss national who is working, has worked or is looking for work in the UK?If 'Yes', please give details below.
You should also give details of your previous studies.
If you are currently working, are you going to continue working during your studies?
If ‘Yes’, please give details.
a6 Do you have ‘settled status’ in the UK?
If ‘Yes’, give the date you received this status.
a7 Have you or your:• husband, wife, civil partner; or• parent(s), a step-parentbeen granted ‘refugee status’ by the UK Government?
If ‘Yes’, and if applicable, give the date this status is due to expire.
If No go to a6
go to b2
YEARMONTHDAY
If No go to a7
go to b2
YEARMONTHDAYgo to b2
If No go to a8
Yes No
Yes No
Yes No
Yes No
If Yes go to b2Yes No
SFW/PTG1F/13146
residence3section
continued
a8 Have you or your:• husband, wife, civil partner; or• parent(s), a step-parentbeen given ‘leave to enter or remain’ in the UK as aresult of a failed asylum application, or discretionary leave where no application for asylum has been made?
If ‘Yes’, and if applicable, give the date this status is due to expire.
YEARMONTHDAYgo to b2
Yes No
b1 In the three years prior to the start of the first academic year of yourcourse, did you live outside the UK and Islands at any time?
b2 Give details of your residence for the three years before the start of the first academic year of your course.Full address Why were you there?
b3 Did you move to Wales wholly or mainly for the purpose of receiving education?
b4 At any time since 1 September 2010 has:• either of your parents, step-parents, guardians; or• your husband, wife, civil partnerlived or worked outside the UK and Islands or, in the case of an EU, EEA or Swiss national, outside the EEA or Switzerland?
If ‘Yes’, please give details below.Full address Why did they live there?
Yes No
YEARMONTHDAY
FromYEARMONTHDAY
To
If you require further space to provide your answer, please give the details requested abovein the Additional notes pages at the back of this form.
If No go to b3
YEARMONTHDAY
FromYEARMONTHDAY
To
YEARMONTHDAY
FromYEARMONTHDAY
ToYEARMONTHDAY
FromYEARMONTHDAY
To
Yes NoIf Yes please contact your LA for advice
Yes No
! If you answered ‘No’ to all the residency and nationality questions in thissection you are not eligible for student finance from Student Finance Wales. Do not continue with this application.
SFW/PTG1F/1314 7
about your courseUniversity/college name and addressIf the course is at a university that is made up of a number of colleges, give the name of thecollege first, followed by the name of the university (for example, Hatfield College, University ofDurham).
Postcode
If the course is franchised to another university/college, give the address of the otheruniversity/college.
Postcode
Give the name of the course you will be undertaking in 2013/14. Give the course subject (forexample, Information Systems). If you are following a combined studies or modular course, listall the subjects.
Qualification you expect to gain (for example, BSc Physics)
Course start date
Course end date
Course length (years)
Current year of course in academic year 2013/14?
First Second Third Fourth Fifth Sixth Seventh Eighth
First time applicantsIs your course a part-time postgraduate Initial Teacher Training (ITT) course? Yes No
YEARMONTH
YEARMONTH
a
b
c
e
f
gh
i
d
4section
If returning applicant go to section 5
SFW/PTG1F/13148
your UK bank or buildingsociety account details5
section
UK bank/building society account details
Sort code
Account number
Building society roll number
_ _
This account must be in your own name and be able to accept direct credits.
Please note that missing or incorrect bank or building society details will result in your grantpayment or bursary (if applicable) being delayed.
SFW/PTG1F/1314 9
University/college sectionUniversity or college staff should check the student’s answers to section 4 beforesigning and stamping this section.Actual course fee to be charged to the student forthe 2013/14 academic year. NB if you are claiming aPart-time Undergraduate Fee Waiver from HEFCWon behalf of the student you will need to insert ‘nil’.
Course start date for 2013/14 academic year:
Course end date for 2013/14 academic year:
SLC or UCAS code for the institution:
I confirm to the best of my knowledge and belief that:
• the student named in section 1 is undertaking the course named in section 4.
• the student is expected to complete this part-time (PT) course in years.
• the equivalent full-time (FT) course would last years.
Intensity of study is calculated by dividing the number of years for FT by the numberof years for PT and multiplying this by 100. Therefore:
• the intensity of study for this course is
• the student's course is designated as eligible for financial support under Regulation 95 of the Education (Student Support) (Wales) Regulations 2012 (as amended).
your university or college
go to section 7
£
FT
PTX 100 = %___________
6section
YEARMONTHDAY
YEARMONTHDAY
• Your university or college need to complete and sign this section. If they do not complete this section your application for student finance will be delayed.
Student information
Student circumstance University/college action required
You are a new student or this is your firstapplication for student finance
To confirm that you have been undertakingyour course in academic year 2013/14 for aminimum of two weeks
You are a continuing student To confirm that you have enrolled on yourcourse for academic year 2013/14
SFW/PTG1F/131410
University or college stamp
YEARMONTHDAY
Your phone number(including area code)
Your email address
Your signature
your university or college
Date
Your full name (in BLOCK CAPITALS)
Your position
6section
continued
SFW/PTG1F/1314 11
about your husband, wife, civil partner or partner
Please give details of your husband, wife, civil partner or partner.
Relationship to you Husband Wife Civil partner Partner
Title Mr Mrs Miss Ms
Forename(s)
Surname
Date of birth
Place of birth (the name of the town or village)
Home address
Postcode
Home telephone number (including area code)
Please ask your husband, wife, civil partner or partner to provide their Customer Reference Number, if they have one
a
b
c
YEARMONTHDAY
7section
SFW/PTG1F/131412
If you and your husband, wife, civil partner or partner are not receiving any benefits,please provide full financial details below.
financial details
b1
If you have ticked any of the boxes above go to section 9
a If you or your husband, wife, civil partner or partner are receiving one or more of the following state benefits, please tick the appropriate box.
Housing benefit
Local Housing Allowance
Council tax benefit
Income Support
Income-based Jobseeker’s Allowance
New Deal Allowance
Income-related Employment Support Allowance
When providing your financial details in this section you must answer every question,entering the amount of income received. You must provide financial details and evidence fortax year 2012-13. The only exception to this is if your course starts in July 2014 in which caseyou need to provide financial details and evidence for tax year 2013-14.If you have no income for a particular source, for example, income from pensions you mustenter 'None' or 'N/A' as the income received. Where you enter an amount other than 'None' or'N/A', you must provide evidence of that amount.
Type of income Amount received before tax (Gross income)
Gross income fromsalary/wages (beforedeductions) from 6 April 2012to 5 April 2013.
Income from self-employment
Bank and building society gross interest (before tax)
Other investment income before income tax
b2
b3
b4
8section
£ You £
£ You £
£ You £
£ You £
£ You £
Type
Type
Husband, wife, civil partneror partner
You
Husband, wife, civil partneror partner
You
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
SFW/PTG1F/1314 13
financial details
Income from any property, lettings or rent
How much of this is through the rent a room scheme?
Any other type of income
Give details of any children who will be totally or mainly financially dependent on you during theacademic year 2013/14.
b5
Type of income Amount received before tax (gross income)
b6
c
£ You £
£ You £Type
£ You £Type
£ You £Type
£ You £Total income
£ You £
Child’s full name Date of birth Relationshipto you
Who will theylive with?
Income from allsources after incometax and socialsecurity contributions
YEARMONTHDAY
8section
continued
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
Husband, wife, civil partneror partner
You
SFW/PTG1F/131414
a Are you a lone parent?
b Are you under 25, living with a partner and claiming for a Childcare Grant or Parents’ Learning Allowance?
c Total (estimated) income after income tax and National Insurance contributions have been deducted for academic year 2013/14.
How much of this will be Child Tax Credit for academic year 2013/14?
You: £
Your partner: £ You: £
Yes No
section
9 Parents' Learning Allowance, AdultDependants' Grant and Childcare Grant
d If you are a lone parent and are not claiming Adult Dependants’ Grant
If you are claiming for Parents' Learning Allowance, Adult Dependants’ Grant or the ChildcareGrant give an estimate of your husband's, wife's, civil partner's, partner's or other adultdependants’ income (after deductions) for academic year 2013/14.
Husband, wife, civil partner Other adult dependantor partner
Income from earnings
Adoption Agency payments
Any disability pension or benefit
Child benefit
Guardian’s allowance
Fostering or boarding out payments
Residence order allowance
Child Tax Credit
Working Tax Credit £ £ Other adult dependant
£ £ Other adult dependant
£ £ Other adult dependant
£ £ Other adult dependant
£
£ Other adult dependant£
£ Other adult dependant£
£ Other adult dependant£
£ Other adult dependant
£ £ Other adult dependant
Yes No
if Yes go to d
if No go to d
go to f
Your partner: £
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
Husband, wife civil partneror partner
SFW/PTG1F/1314 15
Husband, wife, civil partner Other adult dependantor partner
All other income
If other, what is it?
If you have provided financial details above specifically to claim for an Adult Dependants’ Grant, please indicate who you want to claim an Adult Dependants’ Grant for:
Your Your Your civil partner or partner Other adult husband wife (if you are 25 or over) dependant
£ £ Other adult dependant
e Give details of financial commitments you have before the start of the course which you, your husband, wife, civil partner or partner will continue to pay for you during your academicyear.
f If you are not applying for Childcare Grant
Do you, your husband, wife, civil partner or partner receive or expect toreceive, the childcare element of Working Tax Credit?
If ‘Yes’, you are unable to get a Childcare Grant. You can however, choose to receive a Childcare Grant instead of the childcare element of Working Tax Credit.
Type: £ Type: £
Type: £ Type: £
Yes No
section
9Parents' Learning Allowance, AdultDependants' Grant and Childcare Grant
continued
go to Declarations
Husband, wife civil partneror partner
SFW/PTG1F/131416
DeclarationsThis application for financial support may be delayed unless you, and the appropriate personnamed in section 7, sign and date the relevant parts.
Before signing, you should read the Data Protection Act in the notes that accompany this form.
Student declaration• I confirm that to the best of my knowledge and belief, the information I have given on this
form is true and complete and I understand that if I have given my local authority (LA) false information, or have not given them complete information, I may not receive financial support, any support I have had may be withdrawn and I could be prosecuted.
• I agree to give my LA any additional information they require to enable them to process my application and agree to tell them immediately if my circumstances change in any way that might affect my entitlement to financial support.
• I understand that if I do not tell my LA about any change in my circumstances, which may affect my entitlement, I may not be eligible to receive any payments that they have told me about, and that I may have to repay all or part of the financial support I have already received in the year.
• I agree that in the event of receiving an overpayment of financial support, I am obligated to repay any of this overpayment in full.
Your full name(in BLOCK CAPITALS)
Your signature DateYEARMONTHDAY
Your decision about bursary and scholarship data sharing consent will not affect yourentitlement to any other financial support available.
If you started your course in academic year 2006/07 or after you may be eligible for a bursaryor scholarship. In order for your university or college to determine and pay any bursary orscholarship to which you may be entitled, we will share some of your personal, financial andcourse details as well as information about your eligibility for student finance with them.
If you do not wish your details to be shared for this purpose, please tick this box.
SFW/PTG1F/1314 17
Declaration for the person named in section 7• I confirm that to the best of my knowledge and belief, the information I have given on this
form is true and complete and I understand that if I have given the local authority (LA) falseinformation, or have not given them complete information, the student may have their financial support withdrawn and I could be prosecuted.
• I agree to supply any further information in relation to the applicant’s application for financialsupport that the LA may ask for and agree to tell them immediately if my circumstances change in any way that might affect this application for financial support.
Your decision about bursary and scholarship data sharing consent will not affect thestudent's entitlement to any other financial support available.In order for the applicant’s university or college to determine and pay any bursary orscholarship to which they may be entitled, we will share some of your personal and financialdetails with them.
If you do not wish your details to be shared for this purpose, please tick this box.
You must now pass this form back to the student.
Now go to page 19 to finalise your application.
!
Your full name(in BLOCK CAPITALS)
Your signature DateYEARMONTHDAY
SFW/PTG1F/131418
Additional notesIf you are providing extra information please clearly mark what section and question theinformation is about.
SFW/PTG1F/1314 19
Voluntary questionsDo not complete the voluntary questions if you applied for student finance for this particularprogramme of study in any academic year up to and including 2012/13.
The following questions are voluntary – you do not have to answer them. Whether or not youanswer will not affect our assessment of your entitlement to support. If you answer bothquestions a and b, the information will be used to help the Welsh Ministers develop their policiesin future. Your local authority will also use your answers to question b to improve their ability todeliver suitable and accessible educational services that meet the varied needs of theircommunities in the future.
Your parents’ education (this includes your natural parents, your adoptive parents, your step-parents, partners of your parents, and your guardians).Do any of your parents (as defined above) have any higher education qualifications, for example degrees and diplomas or certificates of higher education? Yes No Don’t know
a
b How would you describe your ethnic origin?White: British (Welsh) British (English)
British (Scottish) British (Other) Irish Any other white background
Black or Black British: African Caribbean Any other black background
Mixed: White and black Caribbean White and black African White and Asian Any other mixed background
Chinese or other ethnic group: Chinese Any other
Asian or Asian British: Indian Pakistani Bangladeshi Any other Asian Background
SFW/PTG1F/131420
ChecklistBefore returning this form please make sure you have done the following:• Fully answered all the questions that apply to you.
• Enclosed all the documents we have asked for as evidence where youhave seen this icon next to a question.
• Signed and dated the relevant declaration(s).
• Asked your university or college to stamp and sign the declaration in section 6 and return it to you. We will not be able to deal with your application unless this section has been completed.
You can apply for a part-time grant at any time in the academic year provided you are within thetime limit. The time limit for applying is usually nine months from the start of the academic year.
Within 6 weeks of returning your completed application form with all the relevant evidence, youwill be sent a letter showing the amount of financial support you will receive.
You must return your completed form to your LA at the address shown either below oron the covering letter sent with this form. The address can also be found by goingonline to: www.studentfinancewales.co.uk and then selecting 'Find my local authority'.
Please remember to pay the correct postage.