Buckinghamshire Adult Learning Learner Support Fund Application

Buckinghamshire Adult Learning
Learner Support Fund Application Form and Agreement
If you need help filling in this form please ask a member of staff
Learner Support Funds (LSF) are available to help learners who are unable to access or complete their
learning due to specific financial difficulties. This help may cover tuition fees, exam fees, materials, travel
and childcare. If you cannot afford to pay these costs, you need to sign the form below and let us know
how we can help you. Providing you meet our criteria and we have funds available, we may be able to
support you. Once we have assessed your application, we will contact you to let you know how much
financial support we can offer.
We do NOT help with short courses (N courses)
Name
Course Title
and Code
Date of
Birth
Student
Number
Your current proof of benefit must be sent back with this form or a copy also signed by a
member of Adult learning staff.
For F courses there are no course fees if you are applying for the categories below.
Please tick which applies
I am aged 19-23 and not qualified to full Level 2 e.g. 5 GCSEs at A* - C,
NVQ2 and I am studying for a full level 2. Proof of age will be required.
I am aged 19-24 and not qualified to full Level 3 or 4 and I am studying for a
full level 3/4. Proof of age will be required.
I have not reached level C in GCSE Maths and/or English and I am studying
GCSE in that subject.

For F courses there are no course fees for students receiving benefits listed
below and we may provide support for other costs.
 For A course we will pay half of tuition fees up to £150.
Please tick which applies.
I receive Jobseekers Allowance (Copies of ES40s will not be accepted)
I receive Employment and Support Allowance (Work Related Activity Group)
I confirm I receive Income Support, Housing Benefit or Council Tax Benefit
(not single occupancy). Universal credit. I am unemployed. I need these
skills to help me get work and I wish to enter employment (Seeking Work F
courses only)
I’m the unwaged partner of someone receiving one of the benefits listed
above I am unemployed. I need these skills to help me get work and I wish to
enter employment (Seeking Work F courses only)
I am an Asylum Seeker who has been legally in the UK pending consideration
of their claim by the home office for longer than 6 months – Please check with
advisor for further Asylum Seeker options
Please tick in the box below the financial help you require. Claim forms will be sent back to
you.
Course code ending in
F
A
Course and exam fees
Travel to and from the centre
 Claim forms must be sent in each term or at the end of the
course
 Mileage of 23p per mile for private cars
 Tickets or receipts will be required when returning your travel
claim forms.
N/A
Learning materials needed to do the course – receipts will be required
with the claim forms.
N/A
If Crèche or Childcare is required please complete sections 4-6 for
additional funding on the longer LSF application form.
N/A
NB Support available up to £75 this academic year.
If we give you financial help:

Please come to all your classes

If you can’t come, please let us know

Work hard and pass your exams
We will check if you come to class and if you are making progress
.
The Student Charter says what Buckinghamshire Adult Learning wants you to do and what we will do for you.
Buckinghamshire Adult Learning can withdraw financial help from learners who do not follow the rules in the charter. If we
have given you financial help for another course and you did not complete it, we will not give you any money for a new course.
I understand that if any of the information is incorrect the balance of the fees is payable. I will promptly tell Buckinghamshire
Adult Learning of any changes to my circumstances. Information provided will be passed to the Skills Funding Agency, which is
registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data but
it also allows for the purposes of detecting fraud.
Funds available to support tuition and other costs are limited; applicants should not assume they will
receive funding until confirmed.
The information given on this form is complete and accurate to the best of my knowledge and
belief.
I confirm that without this financial help I would not be able to complete my learning
Signed
Date
Print name
Please return this form to Data Centre, Evreham Adult Learning Centre, Swallow Street,
Iver, SL0 0HS within 10 working days Tel 01296 383582
email
[email protected]
FOR OFFICE USE ONLY
Type of benefit seen/dated
Original seen by/date
Date sent to Data Centre
Amount of LSF paid
Tuition fees
Exam fees
Learning materials
Supplements
Total Claimed
£
£
£
£
Travel receipt received
Crèche Co-ordinator emailed
Exceptional Learning support
applied for
Child care confirmed