Part 6: Student’s expenditure Part 5: Student’s income Please complete where applicable Please complete where applicable Year Parents Learning Allowance/ A Composite Living Costs Year Lone Parents’ Grant Food/Household/Laundry Adult Dependants’ Grant Gas Childcare Grant Electricity Care Leavers’ Grant Water sabled Students’ Allowance Telephone (DSA) TV licence Net earnings Contents insurance Parental/Partner contribution Council Tax Tax Credit Subtotal 6A Working Tax Credit Child Benefit B Other Living Costs Year Housing/Council Tax Benefit Fees Income Support Rent/Mortgage Jobseekers’ Allowance Childcare costs Professional/Career Travel costs (home to Development Loan institution) Scholarships/Trusts/Grants Travel costs (daily travel (please specify) during term time) sability benefits (please specify) Private vehicle (road tax/fuel/insurance/maintenance etc) Books/equipment/course costs Other income including savings (please (including photocopying) specify) sability costs not covered by DSA (please specify) Insurance (excluding car/ contents insurance) costs (please specify) Subtotal 6B Overall total (6A + 6B)
Part 5: Student’s income Please complete where applicable Year Parents Learning Allowance/ Lone Parents’ Grant Adult Dependants’ Grant Childcare Grant Care Leavers’ Grant sabled Students’ Allowance (DSA) Net earnings Parental/Partner contribution Tax Credit Working Tax Credit Child Benefit Housing/Council Tax Benefit Income Support Jobseekers’ Allowance Professional/Career Development Loan Scholarships/Trusts/Grants (please specify) sability benefits (please specify) Other income including savings (please specify) Part 6: Student’s expenditure Please complete where applicable A Composite Living Costs Year Food/Household/Laundry Gas Electricity Water Telephone TV licence Contents insurance Council Tax Subtotal 6A B Other Living Costs Year Fees Rent/Mortgage Childcare costs Travel costs (home to institution) Travel costs (daily travel during term time) Private vehicle (road tax/fuel/insurance/maintenance etc) Books/equipment/course costs (including photocopying) sability costs not covered by DSA (please specify) Insurance (excluding car/ contents insurance) costs (please specify) Subtotal 6B Overall total (6A + 6B)
Application%20Form%20-%20SAS%20Hardship%20Grant.docx