Article 26 Scholarship Award Application Form 2016-17

Important: please read the eligibility, guidance and Terms and Conditions notes very carefully before completing this form.

Checklist of supporting documents 1 Personal Statement 2 Reference 3 Please indicate if you can provide the following: Home Office letter confirming your current immigration status and/or outcome of your asylum application Home Office authorisation form Passport and visa or biometric identity document Letter from the Home Office confirming you have made an application and are awaiting a decision A letter from your solicitor confirming your application to the Home Office Proof of entry to the UK e.g. entry stamp on passport or it may be stated on one of the forms of the above) Proof of current residency (e.g. bank statement, tenancy agreement) Any other documentation relevant to your asylum/human rights application

Part 1 – Your personal Details University of Birmingham student ID Number Family Name Forenames (in full) Date of Birth Date Month Year

UCAS Personal ID Email Address Postal Address

Part 2 – Intended course of study at the University of Birmingham 2016/17 Full Course Title Expected course completion date Month Year

Qualification (e.g. BA, BSc)

Part 3 – Leave to Remain Please tick the box that best describes your current status in the UK: I am an asylum seeker and I am awaiting a decision on my application for refugee status I am the child of an asylum seeker and we are awaiting a decision I have been awarded Refugee status with indefinite leave to remain (ILR) My application for asylum has been refused and I have been awarded either: Discretionary leave (DL) Humanitarian Protection (HP) Other limited leave (please provide full details in your personal statement) I am appealing an asylum (please provide full details in your personal statement) When does your current/most recent visa expire? Date Month Year

If you are waiting on a decision when did you apply? Date Month Year

Did you apply before your previous visa expired? Yes No Not sure Please note: You are required to sign an Authorisation form as the Univeristy will liaise with the Home Office to clarify your immigration status. Article 26 Scholarship Award Application Form 2016-17

Part 4 – Eligibility for funding Please tick to confirm that you have checked your entitlement for statutory student support. The eligibility criteria is detailed here: http://www.ukcisa.org.uk/International-Students/Fees--finance/Government- StudentSupport/Applying-in-England/Who-is-entitled/ I am not eligible for statutory student support

Other general information: Please confirm if you also meet any of the following criteria In am a care leaver (a care leaver is a young person, under the age of 25 who is currently or has been in public care for a minimum of three months. This would include foster care, semi-independent living, residential care homes) I am a carer (a carer is someone who, without payment, provides help and support to a friend, neighbour or relative who could not manage otherwise because of frailty, illness or disability) I am estranged from my family or came to the UK as an unaccompanied minor I am responsible for a child(ren) under 18

Part 5 – Referee You will need to provide a supporting statement from a professional referee to complete your application Referee’s details Referee’s Name Role in organisation Organisation name Organisation Address

Referee’s phone number Referee’s email The supporting statement should be no longer than 750 words and should answer the following questions:

1. What are the applicant's personal and financial circumstances and what barriers have they overcome to continue their education? 2. How well suited is the applicant to the Higher Education course that they plan to take and how realistic are the student's ambitions?

3. What contribution, to the referee’s knowledge, has the student made to college life and/or their community?

4. Is there any other information that the referee believes is relevant to the student's application?

5. How does the referee think the student would benefit from the scholarship offered by the University of Birmingham?

Part 6 – Personal Statement Please submit a written supporting statement answering the following questions in no more than 500 words (total). 1. What are your personal and family circumstances and what barriers have you overcome in order to continue with your education? 2. Please include information on when you arrived in the UK, what is your country of origin and what is the current status of your application for asylum. You do not need to give details of the events that led to your seeking asylum unless you wish to do so. 3. Why have you chosen the University of Birmingham, your particular course of study, what are your ambitions for the future and how would the Article 26 Scholarship help you to achieve these ambitions?

Part 8 – Declaration By ticking this box, you are declaring that the information you have given on this form is complete and accurate to the best of your knowledge and belief. You have read the eligibility criteria and believe you are eligible to apply for this scholarship. You understand that you are required to submit a supporting reference and evidence of your asylum status to complete your application. You will also inform the University immediately if your circumstances change. Declaration tick box: Article 26 Scholarship Award Application Form 2016-17

Signature: Date:

The information provided by you will be used solely for the purpose of assessing your eligibility for this award. Your information will be held by the University of Birmingham in accordance with the University's Data Protection Policy which can be found at: http://www.birmingham.ac.uk/university/governance/policies- regs /data-protection.aspx