17. Is this your final year? YES NO ⃝ ⃝ 18. Is this your second degree? YES NO ⃝ ⃝ Part 3: Your Dependents 19. Do you have any children who are financially dependent on you? YES NO ⃝ ⃝ List Name and Date of Birth of each child below: 20. Do you have any adults who are financially dependent on you? YES NO ⃝ ⃝ List name and Date of Birth of each adult below: Part 4: Disability / Special Medical Needs 21. Do you have a disability or chronic medical condition? YES NO ⃝ ⃝ 22. Have you applied for Disabled Students Allowance (DSA) YES NO ⃝ ⃝ 23. If you are eligible for DSA, do you wish to apply for financial assistance towards any special equipment / materials? YES NO ⃝ ⃝ If yes please give details:
17. Is this your final year? ⃝ YES ⃝ NO 18. Is this your second degree? ⃝ YES ⃝ NO Part 3: Your Dependents 19. Do you have any children who are financially dependent on you? ⃝ YES ⃝ NO List Name and Date of Birth of each child below: 20. Do you have any adults who are financially dependent on you? ⃝ YES ⃝ NO List name and Date of Birth of each adult below: Part 4: Disability / Special Medical Needs 21. Do you have a disability or chronic medical condition? ⃝ YES ⃝ NO 22. Have you applied for Disabled Students Allowance (DSA) ⃝ YES ⃝ NO 23. If you are eligible for DSA, do you wish to apply for financial assistance towards any special equipment / materials? ⃝ YES ⃝ NO If yes please give details:
2017-18-he-hardship-fund-application-form.docx