Student Assistance Fund 2015/2016

STUDENT ASSISTANCE FUND 2015/2016

 The Student Assistance Fund is co-funded by Irish Government and European Union under the European Social Fund Human Capital Investment Operational Programme 2014-2020 – ‘Investing in your Future’  Online applications must be complete prior to submission of form SAF 2.1 and supporting documents. Incomplete applications will not be considered.  Return your completed SAF 2.1 form and supporting documents to Room A101, St Patrick’s Campus, Dublin City University, Dublin 9 Deadlines:

Online Application + Supplementary Application Form SAF 2.1

Monday 19 th October @ 5.00pm

Please complete form and return to (after you have completed the online application form):

Room A101, St Patrick’s Campus, Dublin City University, Dublin 9 - Queries to: [email protected]

To Be Completed By Student Student Name: Student Number: Which categories of assistance are you applying for? (Max. of 2 Categories)* 1. Rent 2. Heat/Food/Living Expenses 3. Books and College Supplies 4. Travel 5. Medical 6. Emergency

Notes:  If there is a family breakdown or extenuating circumstances and you are under 23 and financially independent, please advise this office.

 In the case of separation/divorce or a death of a parent/guardian and you are unable to provide income details, please provide evidence of the situation. E.g. copy of separation papers, copy of death certificate.

 All students must submit supporting documents to supplement their online application.

 If you have not applied online, please do so before submitting this form

SAF 2.1 Supplementary Application Form COMPULSORY

Section 1: Partner’s/Parent’s/Guardian’s/Spouse’s Income Details Occupation Spouse/Guardian 1/Parent 1 Amt per week/month/year? Occupation Partner/Guardian 2/Parent 2 Amt per week/month/year? Other Income Amt per week/month/year? No. of dependent children No. of children in higher education

Section 2: Student’s Annual Budget *

Academic Year - *Multiply monthly incomings x 9 or multiply weekly incomings x 36 Income - 9 Months (€) (€) SUSI € Carers Allowance € Scholarship/Bursary/Award, etc. € Health Board Payments € Allowance from parents/guardian € Charitable Support € Allowance from partner/spouse € Childcare Support € Lone Parents Allowance € Maintenance Support € Back to Education Allowance € Income from Employment € Disability Allowance € Access Grant € Rent Allowance € Summer Work Savings € Family Income Supplement € Other € Total Income

Expenditure - 9 Months (€) Rent/Mortgage € Childcare € Daily Transport to College € Car Tax € Transport at Weekends € Car Insurance € Gas/Electricity/Oil € Medical Insurance € Groceries/Food € Extra-Curricular Activity € On/Off Campus Meals € TV Licence € Internet € Bin Charges € Phone/Mobile € Water Charges € Medication € Other € College Materials € Total Expenditure € College Books €

Reason for applying ______

Section 3: Supporting Documents

SAF 2.1 Supplementary Application Form

 Depending on what student category you are in will depend on what supporting documentation you will need to submit.  If you have applied to SUSI, you do not need to provide proof of income for your family. If however you are declined from SUSI at a later date, you will need to provide proof of income for your family.

Student Assistance Fund Documents Required Students under 23 on the January 1st 2015 Supporting Documents Choose one or more from A, B and C (for parents/guardians) A. PAYE - P21 or P60 for 2014 B. Welfare - Social Welfare Statement for 2014 C. Self Employed - Notice of Assessment for 2014 Student that provides a letter for confirmation of Susi Grant are not required to submit any of the above Grant Applicants Copy of letter from SUSI confirming grant for 2015/2016 All Applicants 2 months bank statements (student)

Student’s over 23 on/before January 1st, 2015 Supporting Documents Choose one or more from A, B and C (for student and/or partner) A. PAYE - P21 or P60 for 2014 B. Welfare - Social Welfare Statement for 2014 C. Self Employed - Notice of Assessment for 2014 Student that provides a letter for confirmation of Susi Grant are not required to submit any of the above Grant Applicants Copy of letter from SUSI confirming grant for 2015/2016 All Applicants 2 months bank statements (student)

If your family income is over the threshold but changes have occurred in 2015, please provide evidence of the following as well as the above.

Supporting Documents Choose one or more from A, B and C A. P45 B. Social Welfare Receipts C. Last 3 months payslips You may be required to provide further supporting documents at a later stage

SAF 2.1 Supplementary Application Form