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Financial Assistance

Student Assistance Fund Application Form 2018-2019

Access_2018  

Fund for Students With Disabilities is funded by the Irish Government and co-funded from the ESF Programme for Employability, Inclusion and Learning (PEIL) 2014-2020.

To be eligible to apply to the Student Assistance Fund, students must be in receipt of at least one or more of the following categories and evidence must be provided. PLEASE TICK THE CRITERIA MOST RELATED TO YOU.

Applications that meet the above eligibility will be considered and assessed on an individual and confidential basis, however, unfortunately not all applications will be successful due to limited funds.

Personal Details

First Name *


Surname *


Student Number *


Date Of Birth *

Select a date from the calendar.

College Term Address
(if different from Home) *


Home Address *


Mobile Number *


Gender *

Are you registered as a Mature Student? *
(23 Years of age on 1st January, preceeding entry)

Are you in receipt of One Parent Family Allowance? *

Are you of Independent means (i.e. no support from parent(s)/guardian)? *

Economic/Social Background - Please indicate which applies to you, if any?

1. Migrant, participant with a foreign background, minorities (including marginalised communities such as the Roma)

2. Participants with disabilities i.e., persons who are registered disabled according to national definition

3. Homeless or affected by housing exclusion according to national definition

4. From rural i.e., thinly populated, area

5. Other Disadvantage

Education/Course Details

Course Of Study *


Campus *


Year Of Study *


Full Time/Part Time *

Course Level *


Are you a Repeat Student? *

If yes, what is the total number of credits you are repeating?


Students highest level of educational attainment, prior to commencement of current course of study: *

Employment Status *

Financial Details

Are you in receipt or have you applied for a SUSI Grant 2018-2019? *

If approved, please specify type of grant:

Are you approved for special rate of maintenance?

Amount


Student Income/Expenditure

Do you have a part-time job? *

If yes, please complete below. If your hours vary, please give approximate hours and pay:

Are you in receipt of Social Welfare Support? *

Do you have a Medical Card? *

Do you receive Rent Allowance? *

Please indicate which applies to you, if any:

Type of Social Welfare Income

Amount Per Week

1

Back to Education Allowance


2

One Parent Family Allowance


3

Rent allowance (Total allowed for the family)


4

Family Income Supplement


5

Social Welfare dependant on Spouse/Partner


6

Carers Allowance/Disability Allowance


Other Income

7

Financial Weekly Support from Parents


8

Income from spouse/partner – Work or Social Welfare


9

Support from family/friend


10

Income from employment


11

Income from maintenance grant


Expenses

Weekly

Rent / Mortgage (Before Rent Allowance Deducted)


Transport To College ( during college term)


How far do you travel to and from college each week

KM per week:

Food / Meals / Groceries


Phone / Mobile


Gas / ESB / Oil


Class Materials


Medication


Childcare Costs


Information in Support of Application

Do you have children dependent on you? *

Childcare Provider

How did you first become aware of the Student Assistance Fund, please indicate *

Have you been allocated SAF in previous years? *

If yes, please specify what years.

For what purpose(s) do you require the fund? *

Is there any other information or circumstance which you believe should be taken into account?

Personal Statement


The information provided is true, complete and accurate and that assistance from other sources has not been received for the stated purpose/service which is the subject of this application. If my SAF application is successful, I agree to use the funds awarded for the purpose outlined above. *

Your application is only complete when you return your supporting documentation. The Access Service will not correspond with students who submit an online application form only.

I understand that the information provided above will be used solely for the purpose of assessing my application and will be handled in accordance with LIT’s Data Protection Policy and Student Privacy Statement. The Policy and Privacy Statement, along with the HEA Data Collection Notice, are available at http://www.lit.ie/Information Compliance/Data.aspx

I also understand that my personal data, including any special category data (e.g. economic/social background) will be shared with the HEA and the ESF for monitoring, statistical and reporting purposes.

By clicking the Submit button below, you are agreeing to your personal data being processed as described. If you have any queries in relation to the processing of your personal data, please contact us in the Access Office or our Data Protection Officer at dataprotection@lit.ie.

After clicking "Submit" you will be redirected back to the SAF homepage. If you are not redirected, please check to ensure all required fields have been filled in.

 
       

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