Individual Application

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Page 1

We would strongly recommend saving your work regularly. If you need to save your work and return to it, please click on link in top right hand corner

Before completing this form please read the guidance notes. Also if you wish to check your financial eligibility, click here. If you wish to see a pdf preview of this form, click here.

If you require assistance in completing this application form, the Walcot Advice/Support project based at Centre 70 in West Norwood may be able to help you. You will need to register online . Once you have completed the Centre 70 registration form, please contact the advisor on 07599 710086 or walcot@centre70.org.uk.

First Name

Last Name

Title

Does this grant application relate to a course that you are on (or planning to go on)?

Does the grant request involve childcare?

Are you currently in school/sixth-form college?

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ELIGIBILITY QUESTIONNAIRE

Do you currently live in the London Borough of Lambeth and have you lived in Lambeth for at least one year?

If you live outside Lambeth but have been looked after (i.e. in care to) the London Borough of Lambeth for at least one year, you should answer yes. If you live at university but your permanent address is in the London Borough of Lambeth and has been so for at least one year, you should answer yes. All students studying full time degree courses need to show evidence that they have lived in Lambeth for at least one year before the course started

Are you or your family (if you are living in the family home) receiving free school meals OR income-based benefits (JSA or ESA or income support) OR earning very low wages or without access to state benefits?

Do you (or your family if you are living in the family home) rent your home through the council, housing association or private landlord?

Are ALL your children aged 3 or over?

Due to high cost of childcare for under 3s (which a Walcot Foundation grant cannot usually cover), we do not support childcare applications for under 3s.

I have never had a career (significant work experience with a significant level of responsibility) or I have been out of work for five years or more.

For university applicants or college applicants aged 24 years and over who are studying (or planning to study) a Level 3 or Level 4 qualification: have you applied to Student Finance?

For university students, we expect you to apply for tuition fee loan, maintenance loan and maintenance grant. For college applicants, we expect you to apply for 24+ advanced learning loan

Do you understand that it can take up to 6 weeks to have a decision on this application (and potentially longer if you have not sent all of the required supporting documentation or if we refer you to one of our partner organisations for budgeting/debt or careers advice)? Therefore, do you agree that any grant would be for future payments made after any grant is awarded and that no grant would be used to reimburse yourself or others for costs you have already incurred or items you have already purchased?

If you have answered ‘no’ to any of the questions above you will not be eligible for a grant from us and should not complete this form

YOU ARE NOT ELIGIBLE FOR A WALCOT FOUNDATION GRANT

You have entered "No" on one of the eligibility criteria and so are not eligible for a grant. You may find other grants on http://www.turn2us.org.uk/.

Page 3

Contact Details

Street Address (please remember to include flat/house number)

City

Post Code

Phone

Mobile Phone

Previous Address Details

Only enter this if you have lived at your present address for less than one year

Personal Information

Gender

Ethnicity

Immigration Status

Date of Birth (DD/MM/YY)

Place of Birth

How many Years in Lambeth

Please just write number - e.g. 9, not "9 years" or "Since 2006"

National Insurance No

Have you had a grant from us before?

How did you hear of us?

Please give name of organisation if appropriate.

Page 4

Education and Employment Details

Previous Education (From secondary school onwards, please list your previous schools and colleges with the most recent first - please also list subjects and qualifications)

Employment History (Concerning any current or previous employment – please list any employment history, starting with the most recent - please include position, start date and end date)

Apart from yourself, how many other people live in your household?

Person 1 - Name

Person 1 - Age

Person 1 - Relationship to Applicant

Person 2 - Name

Person 2 - Age

Person 2 - Relationship to Applicant

Person 3 - Name

Person 3 - Age

Person 3 - Relationship to Applicant

Person 4 - Name

Person 4 - Age

Person 4 - Relationship to Applicant

Person 5 - Name

Person 5 - Age

Person 5 - Relationship to Applicant

Details of all other people not listed above in your household

Please give details (Name, Age, Relationship to you)

Landlord Details

Page 5

FINANCIAL INFORMATION

Are you in receipt of Free School Meals?

FINANCE DETAILS

Please provide this information about yourself (and if you are living in the family home - the head/s of household). We know that you and your family will have other expenses in addition to those listed below. However, these are not included in our financial eligibility calculation, so please do not list them. You must complete this section carefully. Without these details we cannot work out whether you are financially eligible for a grant and your application will be returned. All income that you enter in this section should match up with the bank statements that you have provided.

Savings Total

Debts and Arrears

Overdrafts, credit card debts, rent arrears, council tax arrears. Please specify in detail - e.g. Rent arrears - £500; Water arrears - £150; Overdraft - £200; Provident - £350

Are you/head/s of household in receipt of Means Tested Benefits?

Do you receive a FULL maintenance grant from Student Finance?

WEEKLY INCOME

Please enter numbers only (no letters or symbols)

Income - Applicant's wage

Income - Partner's Wage

Income - Parent's wage

Income - Second parent's wage

Income - Income Support

Income - Pension Credit

Income - Job Seekers Allowance

Income - Employment Support Allowance

Income - Universal Credit

Income - Child Benefit

Income - Child Tax Credit

Income - Working Tax Credit

Income - Child Support Payments

Income - Bursary (e.g. 16-19 Bursary Fund or NHS Bursary)

Income - Student Loan

Income - Student Grant

Income - DLA/PIP

Income - Attendance/Carers Allowance

Income - Other

Income - Other - Details

Weekly Income Total

WEEKLY EXPENDITURE/OUTGOINGS

Please enter numbers only (no letters or symbols)

Expenditure - Rent (excluding arrears)

Amount that you pay DIRECTLY

Expenditure - Council Tax (excluding arrears)

Amount that you pay DIRECTLY

Expenditure - Service Charge (excluding arrears)

Expenditure - Water Rates (excluding arrears)

Expenditure - Gas/Electricity (excluding arrears)

Expenditure - Childcare

Expenditure - Childcare - Details

If you have listed childcare costs above, please break them down here (i.e. number of hours/days per week; cost per hour/day - PLEASE NOTE - this is for EXISTING childcare costs that you are CURRENTLY paying for

Weekly Expenditure Total

Page 6

Course Details

Course Name

College/Training Provider

College/Training Provider Address

College/Training Provider Telephone

25 characters maximum

Course Start Date (DD/MM/YY)

Course End Date (DD/MM/YY)

Course - FT or PT?

Course Level

Course Entry Requirements

Course Expected Qualifications

Your Grant Request

Grant Request Short Summary

In a few words (maximum 50 characters), sum up your grant request. For example, "Childcare costs to help attend course" or "Buying tools to help secure apprenticeship"

Childcare Provider Name

Childcare Provider Email address

Childcare Ofsted Registration Number

Childcare Costs - How much are you requesting?

Please give details on your childcare costs

Give details of how much your childcare will cost. Please be clear if this cost is daily, weekly or monthly. Also give details of the hours of childcare (e.g. full time, Monday mornings etc)

Could you give details why your partner and/or extended family are not able to provide regular childcare?

What non-childcare items are you applying for how much will each item cost?

Please explain very specifically WHAT you are applying for with a clear breakdown of costs.

How would you make use of the Walcot Grant? (£500 per term - £1500 in total)

For example, tell us how you will spend the grant e.g. towards course related items, travel, university accommodation fees etc. Please be as specific as you can

Non-Childcare Costs - How much are you requesting?

Total Requested Amount

How will this grant help with your course/situation?

What is your long term career goal (i.e. what job do you want to do) and how does your planned course help you?

What steps do you plan on taking to fulfil your long term career goal?

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REFEREES

Ref1-Title

Ref1-FirstName

Ref1-Surname

Ref1-Relationship

Ideally, this referee should be your current or most recent tutor.

Ref1-Address

Ref1-Email

Ref1-Telephone

Ref2-Title

Ref2-FirstName

Ref2-Surname

Ref2-Address

Ref2-Relationship

Ref2-Email

Ref2-Telephone

PAYMENT DETAILS

Payee Account Name (e.g. John Smith)

Length of Payee Name should be 18 characters max. Letters/Numbers only - no special characters

Account Number

Sort Code

No hyphens - just numbers

Bank Name

Cheques should be payable to

Page 8

Additional Documentation

If there are problems with attachments, you can send the documents to Walcot Foundation, 127 Kennington Road, London SE11 6SF or email to grants@walcotfoundation.org.uk. Please note that the maximum size of each file is 5MB.

Confirmation of your identity, such as a copy of your birth certificate, medical card, passport or similar document (NB: This is not required if you have had a past grant from The Walcot Foundation)

Sending by postN/A

Proof of one year's residence in Lambeth, such as a copy of a utility bill or tenancy agreement that is more than one year old. If you are not living in Lambeth but are in care to Lambeth, please provide a housing office letter or similar on official letterhead confirming that you have at least one year's connection to Lambeth.

Sending by post

Proof of immigration status. If you do not have British or EU citizenship, please provide proof of Indefinite Leave, Humanitarian or Discretionary Leave to Remain in UK. If you are an asylum seeker or have Humanitarian/Discretionary Leave to Remain (Limted Right to Remain), we require proof that you are actively working on your immigration case in order to obtain citizenship or indefinite leave to remain (e.g. a recent letter from your solicitor about the status of your case).

Sending by postN/A

For students, proof of enrolment on your course for the current academic year (or, if you have not yet enrolled, official confirmation of your acceptance on to the course or offer letter from the university)

Sending by postN/A

For University applicants, a copy of your Government Student Loan/Grant award/refusal letter. Please ensure you include the ‘Student Finance Breakdown’ portion of your letter.

Sending by postN/A

For requests for child care support, a copy of either quote or invoice from a registered child care provider with a breakdown of childcare charges.

Sending by postN/A

Proof of low income. This should be a) Signed letter from school confirming that you are in receipt of Free School Meals OR b) Copy of means tested benefits letter from parent dated within last two months OR c) copies of the last two bank statements for the head(s) of household. For all benefits, tax credits and wages that your head(s) of household receive, we must see the last two bank statements of the accounts these are paid into. On the copies of the last two bank statements (again, all current and savings accounts), we ask that your parent/carer make notes against entries to explain the source of incoming funds if they are not already clearly marked (for example, deposits and bank transfers).

Sending by post

Your Bank Statement: We need a copy of a recent bank statement for the bank account that the grant would be paid into. This should be in your name.

Proof of Low Income: We need copies of your last two bank statements and copies of the last two bank statements for the head(s) of household. We need the last two bank statements for all bank accounts (that is, all current accounts and all savings accounts). For all benefits, tax credits and wages that you and the head(s) of household receive, we must see the last two bank statements of the accounts these are paid into. On the copies of the last two bank statements (again, all current and savings accounts), we ask that the applicant make notes against entries to explain the source of incoming funds if they are not already clearly marked (for example, deposits and bank transfers). [NB: If you (or your parents/carers) accept payments from friends, relatives or others into your bank account because these individuals do not have their own bank accounts, that money will be counted as income to you. That may put you over the eligibility threshold for a grant.] Not sending all bank statements and not making notes on them is the most common reason for delays in processing applications. Please be sure to include these with your application. If you do not your application will be returned. If you (or your parents/carers) do not have a bank account, please contact the Walcot Advice/Support project based at Centre 70 advice centre in West Norwood on 07599 710 086 or walcot@centre70.org.uk for assistance with completing this application.

Sending by post

Any other documentation you wish to submit that you feel is relevant to your application.

Please send any hard copies to:

The Grants Team
The Walcot Foundation
127 Kennington Road
London
SE11 6SF

Please ensure that you include a covering letter so that we can match your documents with this application.

Page 9

DECLARATION

I certify that the information that I have given in this application is true and complete. (Please note that a decision will be based on the information given on this form. If a grant is awarded and the information is subsequently found to be incorrect, any grant that had been awarded could be withdrawn and you could be asked to repay any monies already paid.)

I understand that the Walcot Foundation may not be able to work with me directly and may ask me to find a recognised referrer to assist in taking my application forward.

If applicable, I confirm I have contacted the Student Finance Officer (or similar) at the institution where I am studying (or plan to study) and have applied for any financial assistance for which I might be eligible

I have no objection to the data contained in this application being held by the Walcot Foundation for the purpose of considering this grant application. For more information on how we handle your personal information, please see our Privacy Policy.

I agree that information I have given may be discussed with representatives of my college/university/training centre/school (if applicable), childcare providers (if applicable), my referees and any organisation that suggested I apply.

I understand that if I am awarded any goods or services my contact details will be passed on to the relevant suppliers in order for them to contact me.

To help the Foundation monitor and evaluate its work, I agree I may be contacted in the future.

I agree that any grant awarded will not be used toward purchases already made or debts.

If awarded a grant, I agree to provide evidence (normally receipts) of any items purchased (e.g. books, travel passes, kit, supplies).

I have read the application's guidelines in full.

Agreement

I agree to the Declaration above

OPTIONAL

Advice Service - I agree that in the event of matters arising from information I have provided (e.g. debts, budgeting, immigration status, student loans/grant eligibility and the like), or if the Walcot Foundation believes that I might benefit from advice in these areas, my details may be passed on to the Walcot Advice/Support Worker based at Centre 70 advice centre in West Norwood and who may contact me directly. I understand that taking up any advice received may be a grant condition.Careers Service - I agree that if the Walcot Foundation believes I might benefit from careers advice, including the possibility of taking up work experience or voluntary work related to my studies, my details may be passed on to the Walcot careers adviser based at High Trees in Tulse Hill and who may contact me directly. I understand that taking up any advice received may be a grant condition.Walcot - I agree that Walcot Foundation may share non-grant information with me that the Walcot Foundation considers may be useful (e.g. Walcot e-newsletter, details on training and other grant programmes etc)

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