UCD Access & Lifelong Learning and UCD Foundation UCD Entrance Scholarship for Widening Participation Mature, Students – with a Disability and QQI-FET Income Declaration Form 2017 This form is for completion by applicants applying from the following groups ONLY: DARE, Students with a Disabilit,. Mature Students, QQI-FET Students Please note completed Income Declaration form and supporting documentation must be sent to before 5pm on the 21st September 2017. Incomplete or late applications will not be assessed by the committee Total income for the year ended 31st December Document Required 2016 Mother/guardian Father/guardian Myself (if relevant) (if relevant) Income from employment (e.g. PAYE P21 for 2016 salary, wages, fees) – Income from self-employment Notice of assessment for 2015 Payments from the Department of Social Protection Social Welfare Statement for 2016 Please tick relevant payment(s): and P21 2016 and Unemployment Benefit __ Notice of Assessment Unemployment Assistance__ 2015 (If applicable) Widows Pension__ Deserted Wives__ One Parent Family Payment __ Family Income Supplement __ Disability Benefit __ Disability Allowance __ DSP-Pension Payment __ Please give details: __________________________________ Other DSP Payment, Please give details: _______________________________ Scholarship Income Letter confirming (e.g. Department of Education, scholarship Community, Corporate) Please give details: _______________________________ Any income Letter/documentation confirming income Please give details: _______________________________
UCD Access & Lifelong Learning and UCD Foundation UCD Entrance Scholarship for Widening Participation – Mature, Students with a Disability and QQI-FET Income Declaration Form 2017 This form is for completion by applicants applying from the following groups ONLY: DARE, Students with a Disabilit,. Mature Students, QQI-FET Students Please note completed Income Declaration form and supporting documentation must be sent to before 5pm on the 21st September 2017. Incomplete or late applications will not be assessed by the committee Total income for the year ended 31st December 2016 Document Required Mother/guardian (if relevant) Father/guardian (if relevant) Myself Income from employment (e.g. PAYE – salary, wages, fees) P21 for 2016 Income from self-employment Notice of assessment for 2015 Payments from the Department of Social Protection Please tick relevant payment(s): Unemployment Benefit __ Unemployment Assistance__ Widows Pension__ Deserted Wives__ One Parent Family Payment __ Family Income Supplement __ Disability Benefit __ Disability Allowance __ DSP-Pension Payment __ Please give details: __________________________________ Other DSP Payment, Please give details: _______________________________ Social Welfare Statement for 2016 and P21 2016 and Notice of Assessment 2015 (If applicable) Scholarship Income (e.g. Department of Education, Community, Corporate) Please give details: _______________________________ Letter confirming scholarship Any income Please give details: _______________________________ Letter/documentation confirming income