Student Assistance Fund Application Form 2017/18

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Student Assistance Fund

Please fill out all sections of the form in one sitting. This form cannot be partially completed. Incomplete applications will not be accepted.

SECTION 1 - YOUR DETAILS
- Student ID Number (e.g X00012345)*
- Your First Name(s)*
- Surname*
- Telephone Number (Mobile)*
- Your Email*
- Gender*
- Date of Birth (Format - dd/mm/yyyy)
  DD
  /
  MM
  /
  YYYY
- Home Address*
  (please include your eircode, this can be found at https://finder.eircode.ie/#/
  Street Address*
  Address Line 2
  City*
  State / Province / Region*
  Zip / Post Code
  Country*
- Is your address for the college year different from your home address?*
- Current Address (If different from home address)
  Please include your eircode, this can be found at https://finder.eircode.ie/#/
  Street Address
  Address Line 2
  City
  State / Province / Region
  Zip / Post Code
  Country
SECTION 2 - COURSE DETAILS
- Course Code*
  As shown on your student ID card
- Course Commencement Date
  The date you commenced your course (for example if you are in 2nd year, your course commenced in 2016)
  DD
  /
  MM
  /
  YYYY
- Course Completion Date
  The date your course will finish (this date could be in 2017, 2018, 2019 etc)
  DD
  /
  MM
  /
  YYYY
- Current Year of Course*
- Are you repeating tuition or exams?*
- How do you travel to and from College?*
SECTION 3 - PERSONAL BACKGROUND SURVEY
(The following questions are a survey of your personal background. These details will only be shared with the HEA who provide IT Tallaght with our SAF Allocation)
- Before starting my course at IT Tallaght I was unemployed, incl. long-term unemployed*
  Out of work, available for work and actively seeking work (ILO definition). Registered as unemployed with the PES. Excludes full-time students and those over 74.
- Before starting my course at IT Tallaght I was long-term unemployed*
  Under 25 years of age with a continuous unemployment spell of over 6 months. 25 years of age or more with a continuous unemployment spell of over 12 months.
- Before starting my course at IT Tallaght I was inactive*
  Not employed and not unemployed. Includes full-time students who are not in employment. Excludes self-employed.
- Before starting my course at IT Tallaght I was inactive, not in education or training*
  Not employed and not unemployed and not in education or training.
- Before starting my course at IT Tallaght I was employed, incl. self-employed*
  Persons in employment. Includes employees, self-employed, family workers. Includes persons on maternity or paternity leave (unless registered as unemployed). Excludes persons who are registered as unemployed but have a small part-time job (as allowed under national definition of registered unemployed).
- Before starting my course at IT Tallaght I was below 25 years of age*
- Before starting my course at IT Tallaght I was above 54 years of age and employed*
- Before starting my course at IT Tallaght I was above 54 years of age and unemployed or inactive not in education or training *
- Highest level of education attainment prior to starting your present course*
- I come from:*
  (Please choose one option from the dropdown menu)
- I come from a single adult household with dependent children*
  No household member is in employment, i.e. all members are either unemployed or inactive.
- I have a Disability*
  Specific learning difficulties (including Dyslexia, Dyspraxia, Dyscalculia); Significant ongoing illness; Multiple disability; Physical/mobility; Deaf/hard of hearing; Blind/vision impairment; Other disabilities (Including ADD/ADHD, ASD (Autistic Spectrum Disorder), Mental Health Conditions)
- I come from migrant, foreign or minority background*
  Migrants (understood as non-national permanent residents in a country). People with a foreign background (according to national definitions). Minorities (according to national definitions), including Roma.
- My background is:
- Other disadvantaged*
  This category covers participants considered to have some form of disadvantage but is not covered by any of the other categories above.
- I am homeless or experiencing housing exclusion*
  Covers persons who are homeless (without a fixed abode) or affected by housing exclusion according to national definitions.
- I come from a Rural area
  Rural areas are to be understood as thinly populated areas.
SECTION 4 - HOUSEHOLD INCOME

YOU WILL NEED TO PROVIDE US WITH SUPPORTING DOCUMENTATION AS PER THE IT TALLAGHT SAF WEBSITE.
- Have you applied for a student grant (e.g through SUSI or an ETB)?*
  Student Universal Support Ireland (SUSI). Education and Training Board (ETB).
- Please tell us why you have not applied for a Student grant
- Have you previously received support from the Student Assistance Fund?*
- Please select the living situation that best describes you.*
  For the purposes of this fund, mature applicants are defined as 23 years old on or before 1st January 2017
- Are you working part-time during college?*
- Name of Employer
- Weekly amount
- Are you in receipt of Social Welfare income?*
  To request a statement of Social Welfare from Department of Social Protection, please visit:
  
  https://www.welfare.ie/en/Pages/secure/OnlineStatementRequest.aspx
- What type(s) of payment do you receive? (e.g Back to Education Allowance, One Parent Family etc)
- Other type of payment you receive
- Amount per week
- Amount of Rent/Mortgage I and/or my family pay monthly
- Amount of Rent/Mortgage Allowance I and/or my family receive monthly
- My home is (Please select the option that applies to you)*
- Father/Guardian Part B (Table A)
- Mother/Guardian Household Income Part B (Table A)
- Spouse/Partner Household Income Part B (Table A)
- Table B - Father (or Guardian) - Occupation
- Table B - Father (or Guardian)- Employment Income (PAYE salary, fees, etc)
- Table B - Mother (or Guardian) - Occupation
- Table B - Mother (or Guardian) - Employment Income (PAYE salary, fees, etc)
- Table B - Spouse/Partner - Occupation
- Table B - Spouse/Partner - Employment Income (PAYE salary, fees, etc)
- Table C - Father (or Guardian) - Occupation
- Table C - Father (or Guardian) - Income from self employment
- Table C - Father (or Guardian) - Pension
- Table C - Father (or Guardian) - Income from land: profits from farming activities
- Table C - Father (or Guardian) - Income from other sources. Specify:
- Table C - Mother (or Guardian) - Occupation
- Table C - Mother (or Guardian) - Income from self employment
- Table C - Mother (or Guardian) - Pension
- Table C - Mother (or Guardian) - Income from land: profits from farming activities
- Table C - Mother (or Guardian) - Income from other sources. Specify:
- Table C - Spouse/Partner - Occupation
- Table C - Spouse/Partner - Income from self employment
- Table C - Spouse/Partner - Pension
- Table C - Spouse/Partner - Income from land: profits from farming activities
- Table C - Spouse/Partner - Income from other sources. Specify:
- Table D - Father (or Guardian) - Type of payment (Jobseekers,Invalidity,One parent family etc)
- Table D - Father (or Guardian) - Amount of payment (weekly)
- Table D - Mother (or Guardian) - Type of payment (Jobseekers,Invalidity,One parent family etc)
- Table D - Mother (or Guardian) - Amount of payment (weekly)
- Table D - Guardian/Spouse/Partner - Type of payment (Jobseekers,Invalidity,One parent family etc)
- Table D - Guardian/Spouse/Partner - Amount of payment (weekly)
- Personal Statement. *
  Please explain why you need financial support. The more information we have, the quicker we can assess the application.
  
  You can also use this opportunity to detail changes in your households income (if any) since 2016.
SECTION 5: DECLARATIONS
NOTE: Failure to select 'Yes' to this question will make your application ineligible for consideration.
- I confirm that the funds which I have supplied for will be used for the purpose intended.*
  NOTE: Failure to select 'Yes' to this question will make your application ineligible for consideration.
- All the information that I have provided in this form 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.*
  NOTE: Failure to select 'Yes' to this question will make your application ineligible for consideration.

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