AberdeenshireCouncil Education,Learning&Leisure WoodhillHouse WestburnRoad Aberdeen AB165GB Tel:01224665577 Fax:01224664615 Email:ema@aberdeenshire.gov.

uk

EDUCATIONMAINTENANCEALLOWANCE(EMA)
SESSION2011/12
COMPLETEFORMINBLACKORBLUEINK FULLNAMEOFSTUDENT SCHOOL DATEOFBIRTH SQACandidateNumber HaveyoureceivedanEMAbefore? Yes No

Afreshapplicationmustbemadeeachacademicyearincludingalloriginal documentationneededtocompletetheassessment.
OFFICIALUSEONLY
EMAReferenceNo. DateApplicationReceived 1 Check
st

2 Check

nd

DateApplicationFully Completed

Approved

EMAStartDate

DateAwardLetterSent

DateLearningAgreement Received

AutumnIntake

WinterIntake

ProvisionalAward

FOROFFICIALNOTES

FinalAward

EducationalmaintenanceAllowances(EMA)
AdditionalGuidance
BothStudentandCarer(s)mustsigntheDeclarationFormonpage10.
Ifyouwerebornbetween1March1992and29February1996youmaybeeligibleforanEMA Ifyouare16yearsofageoroverbefore30September2011,youmaybeeligibleforanEMAfrom thebeginningofschoolterm. Ifyouare16yearsofagebetween1October2011and29February2012,youmaybeeligiblefor anEMAfromJanuary2012 Forthoseeligibleforfullyearaward,iftheapplicationisnotsubmittedby30September2011,the awardcanonlybemadefromtheweekitisreceivedbythisoffice ForthosewhoareeligiblefromJanuary2012iftheapplicationisnotsubmittedby29February 2012theawardcanonlybemadefromtheweekitisreceivedbythisoffice. Thecutoffdateforprocessingapplicationformsforacademicyear2011/12is31March2012.No applicationswillbeprocessedafterthisdate. HouseholdincomeisnormallyassessedongrosstaxablehouseholdincomefortheperiodApril 2010toMarch2011. TheincomethresholdsfortheEMAProgramme,AcademicYear2011/12areasfollows: Income Noofdependent childrenin household 1 2+ Award

020,351 022,403

30 30

Dependentchildrenareallthoseuptotheageof16andthoseovertheageof16anduptotheage 25iftheyareinfulltimefurtherorhighereducation.Youwillhavetoprovideevidenceoffurtheror highereducationforthosebetween16and25 Ifyouarereceivingeducationwhilelivinginafosterhomeorchildrenshome,andareinthecareof thelocalauthorityorlivingindependentlyinreceiptofIncomeSupportorcontributionsbased EmploymentandSupportAllowance,youareeligiblefora30EMAawardwithouthavingto provideevidenceofhouseholdincome. Ifsuccessful,youmustcompletealearningagreementandadheretothetermsofthatagreement. Ifsuccessful,youmustattendschoolforaminimumof21guidedlearninghoursperweek (timetabledhoursincludingstudyperiods). Ifsuccessful,youwillonlyreceiveEMApaymentsforthoseweekswhereyouhavemaintained 100%attendance(includingauthorisedabsences)andacceptablepunctualityandconduct. Studentsmaybeeligibletoreceiveaprovisionalawardifaselfemployedparentistemporarily unabletosupplydetailsinwhichafinalsettlementcanbemade.Pleasedetailschangein circumstancesanddateofchangeintheAdditionalInformationsectiononpage12.

Afreshapplicationmustbemadeeachacademicyearincludingalloriginal documentationneededtocompletetheassessment.

EducationalMaintenanceAllowances(EMA)
ApplicationContactAddress
AFIRSTCLASSSTAMPWILLNOTBESUFFICIENTPOSTAGEWHENSENDINGINYOUR COMPLETEDAPPLICATIONFORM.POSTAGECHARGESARENOWBASEDONWEIGHTAND SIZE. PLEASECHECKPOSTAGEPRIORTOSENDINGYOURFORM. Pleaserefertothechecklistonpage11priortosubmittingyourform. PleasewriteinBLOCKCAPITALSwhencompletingtheapplication. Pleasecompletetheapplicationformandsendittothefollowingaddress:

AberdeenshireCouncil Education,Learning&LeisureService EMATeam WoodhillHouse WestburnRoad Aberdeen AB165GB

IFYOUAREPOSTINGYOURAPPLICATIONYOUMUSTENCLOSEASTAMPEDADDRESSED ENVELOPE(9X6INSIZE)FORPERSONALDOCUMENTSTOBERETURNED. DATAPROTECTIONACT TheCouncilisunderobligationtomanagepublicfundsproperly.Accordingly,the informationthatyouprovidewillbeusedtoensureallsumsduetotheCouncilarepaid timeously,e.g.byidentifyingpersonswhoarenonpayersofcounciltaxandtoimprovethe uptakeofbenefits. Theinformationmayalsobeusedtopreventanddetectfraud.Itisalsopossiblethatthis informationmaybesharedforthesamepurposeswithpublicbodies,includingneighbouring councilsorotherorganisationswhichhandlepublicfunds.

EducationMaintenanceAllowance(EMA)isaprogrammefundedbytheScottishGovernmentand administeredtoLocalAuthorityEducationDepartmentsforschoolsthroughoutScotland.The ScottishGovernmentandLocalAuthoritiesarecontrollersinrelationtoyourinformation. Theinformationyousupplyshallbeusedforthepurposesofassessment,award,paymentand wherenecessary,recoveryoftheEMAandwewillprovideinformationtotheScottishGovernment, allinaccordancewiththerequirementsintheScottishGovernmentEMA(Scotland)Business Model. Wemaycheckinformationprovidedbyyou,orinformationaboutyouprovidedbyathirdparty,with otherinformationheldbyus.Wemayalsogetinformationaboutyoufromcertainthirdparties,or giveinformationtothem,tochecktheaccuracyofinformation,topreventordetectcrime,orto protectpublicfundsinotherways,forresearchorstatisticalpurposes,aspermittedbylaw.These thirdpartiesincludeothergovernmentdepartments. WewillnotdiscloseinformationaboutyoutoanyoneoutsideourLocalAuthorityunlessthelaw permitsusto.

PartA
Section1(A):PERSONALDETAILSCompletedbyStudent Gender
FirstName(s) Surname(s) Emailaddressofapplicant CurrentHomeAddress

Male

Female

DateofBirth(Day/Month/Year)

/19

Postcode

HomeTelephone

Mobile

Section1(B):PERSONALNATIONALITYANDRESIDENCYDETAILS HowlonghaveyoulivedintheUnitedKingdom?From / / No

Haveyoulivedatyourpresentaddressforlongerthan3years?Yes

Ifno,pleasetellusyourpreviousaddress(es)withinthelast3years,includingthoseabroad. From / / To / / Address1

Postcode From Address2 / / To / /

Postcode Residency:pleaseticktherelevantbox:
UK Enter/Remain Noneofthese EU/EEANational/SwissNational SettledStatus/ExceptionalLeaveto

RefugeeStatus/TemporaryProtection/HumanitarianProtection

From

To

Ifrequired,pleaseusetheadditionalinformationpageattheendoftheapplication form.

Section2:COURSE/SCHOOLDETAILSCompletedbyStudent NameofSchool Address

Postcode
Areyouattendingschooland/orcollegeforatleast21guidedlearninghourseachweek? Yes No Ifno,doyouhaveflexiblestudyarrangementstomeetyourparticularneeds,i.e.duetoamedical condition? Yes No Pleasestatereasonwhyyouwillbeattendingschoolforlessthan21guidedlearninghours.Please useAdditionalInformationsectiononpage12ifrequired.

Whichyearofstudywillyoubeundertaking?S4

S5

S6

Other

IfyoureceivedanEMAawardlastyear,towhichLocalAuthoritydidyouapply,andwhatschooldid youattend?

Section3:BANK/BUILDINGSOCIETYACCOUNTDETAILSCompletedbyStudent
Nameofpersonholdingaccount Theaccountmustbeinthestudentsnameunlesstherearespecialcircumstances. IstheaccountholdertheEMAstudent?Yes No Ifitisnot,pleasestatereasononAdditionalInformationsectiononpage12. NameandAddress oryourBank/ BuildingSociety Bank/BuildingSocietySortCode(6digits)

AccountNumber(8digits)

Roll/ReferenceNumber(ifapplicable)

Anychangestoyourbank/buildingsocietyaccountmustbemadeinwritingimmediatelytothe EMATeamatAberdeenshireCouncil

Section4:INDEPENDENTSTATUSCompletedbyStudent
DoyoureceiveIncomeSupportorcontributionsbasesEmploymentandSupport Allowanceinyourownright? Yes Ifyes,areyoulivingunderthecareoftheLocalAuthorityorwithfosterparents?Yes No No

Section5:FAMILYDETAILSCompletedbyStudent Whodoyoulivewith?(pleasetickallthatapply) Mother Father Motherspartner Fatherspartner Onmyown EMAapplicantspartner

Grandparent(s) Otheradults

Fosterparent(s) pleasespecify No

Incare

Loneparenthousehold? Yes

Ifyes,pleaseprovideproofsuchasaCouncilTaxbill

Howmanydependentchildrenarelivinginthehousehold? (Full)NameofOtherDependents DateofBirth Nursery/School/LearningCentre

Parent/Carer1Parent/Carer2 Name(includetitle) PermanentAddress

Postcode RelationshiptoApplicant Occupation(s)heldduringtax year2010/11 MaritalStatus ContactNumber

EMAapplicantsmustnowsigntheStudentDeclarationatSection7(A)onpage10

Section6(A):HOUSEHOLDINCOMECompletedbyParent(s)/Carer(s)
HaveyouincludedarelevantcompletedTaxCreditAwardNotice(TCAN)TC602withyourapplication form?Yes No N.B.Thisshouldshowtheactualincome,notanestimate Ifyes,pleasegotoSection7(B)

Section6(B):HOUSEHOLDINCOMECompletedbyParent(s)/Carer(s)
WherethereisnoTCANavailable,thefollowingincomedetailsarerequired. Pleaseenternilvalueifnotapplicable.Valuesshouldbeannualamountsfor2010/11. TAXABLESOCIALSECURITYBENEFITSAMOUNTRECEIVEDIN2010/11. Parent/Carer1 CarersAllowance(previouslycalledInvalidCareAllowance) Includinganychilddependencyincrease. ContributionsbasedJobseekersAllowance DonotincludeanyamountsofincomebasedJobseekers Allowance.IfyoustartedworkandgaveyouremployeraP45U showingthesedetails,donotincludethemhere. ContributionsbasedEmploymentandSupportAllowance PleasestateanyContributionsbasedEmploymentandSupport Allowancereceived IncapacityBenefit Includebenefitpaidafterthefirst28weeksofincapacity(asthe shorttermhigherandlongtermrates)togetherwithanychild dependencyincrease.Ifanytaxwasdeductedfromyourbenefit, entertheamountduebeforethetaxwastakenoff Donotincludebenefitpaidinthefirst28weeksofincapacity(at theshorttermlowerrate)orbenefitpaidforaperiodofincapacity thatbeganbefore13April1995andforwhichInvalidityBenefit usedtobepayableoranychilddependencyincreasewiththese payments. IfyoustartedworkandgaveyouremployeraP45Ushowingthese details,donotincludethemhere. IncomeSupport Thisisonlytaxableifitispayabletoamemberofacoupleandthe recipient(butnottherecipientspartner)isonstrike. DonotreportIncomeSupportifitisnottaxable. Parent/Carer2

SOCIALSECURITYBENEFITS

Areyouinreceiptofnontaxablesocialsecuritybenefits?Yes

No

Ifyes,pleasesendpartCtoDWPtobecompleted.

EARNINGSFROMEMPLOYMENT(INCLUDINGSELFEMPLOYMENT)IN20102011
Parent/Carer1 Parent/Carer2

Totalgrossemploymentincomefromalljobsafterdeductionof Pensioncontributions,and Deductionstocharityviagiftaid Butbeforetakingoff TaxandNationalInsurancecontributions,and ShareIncentivePlandeductions Include Yourtotalprofitsminuslossesfromselfemployment Anytipsorgratuitiesyoureceive AnyStatutorySickPayyoureceive Thetaxablepartofanyterminationpayments Taxablesecuritiesoptionsgains Anystrikepayyoureceived Paymentsforanyworkdonewhilstyouwereservingasentencein prisonoronremand(thiscountsasincomefortaxcreditpurposes eventhoughitisnottaxableasearnings) Deductanyallowableexpensesyouhaveincurred (seeGuidanceforcompletingapplicationform2011/12)

Deductuptothefirst100foreachweek(forexample,ifyoureceived 80pleaseentre0,ifyoureceived120pleaseenter20)you receivedStatutoryMaternityPay,StatutoryPaternityPayand StatutoryAdoptionPay(fortaxcredits.100aweekofeachpayment isignored)

BENEFITSFROMYOUREMPLOYER(S)IN20102011
Typeofbenefit Goodsorassets Yourliabilities(bills,etc)paidbyemployer Vouchersandcredittokens Carmileageallowancesorrunningcosts Companycars Carfuel Taxableexpensespayments Parent/Carer1 Parent/Carer2

NOTIONALINCOME Capitaltreatedasincome(e.g.stockdividend). Parent/Carer1 Parent/Carer2

Trustincomethatundertheincometaxrulesistreatedasthe incomeofanotherperson,e.g.investmentincomeofaminor childwheretrustfundshavebeenprovidedbyaparentandthe amountexceeds100. Incomeyouwereentitledtobutdidnotapplyfor,e.g.ifyou wereentitledtoclaimCarersAllowancebutdidnotclaimit. Incomeyoudeprivedyourselfof,e.g.ifyouselltherighttoan occupationalpensionworth10aweekfor2500shouldnot beincludedbutyoushouldadd10aweektoyourincome.

Incomeyouhavedeprivedyourselfof(e.g.incomenottaken becauseyouworkedforlessthanthegoingrate(orfornothing) butwherethepersonforwhomtheworkwasdone,orfor whomtheservicewasprovided,hasthemeanstopay.This doesnotapplytovoluntaryworkoremploymentortraining programmes.

UKPENSION
Parent/Carer1 WidowedParentsAllowance. StatePension. OtherPensions.Personalpensionplanorretirementannuity contracts. Parent/Carer2

SAVINGS
Parent/Carer1 Grossincomefrominvestments/savings/shares,etc.include interestfromanybankorbuildingsocietyaccounts(thisis incomebeforetaxwasdeducted). Parent/Carer2

Ifyoureceivedanycompanydividendsaddthetaxcredittothe dividend.

PROPERTY/TRUST/FOREIGNINCOME
Parent/Carer1 IncludeincomefrompropertyorlandintheUKthatyouowned orleasedout(ifthiswaspartofyourbusinessincomeincludeit aboveatincomefromselfemployment. Grossincomefromatrust,settlementoradeceasedpersons estate(thisistheincomebeforetaxwasdeducted). ForeignIncome:Includethegrossamount,inBritishpounds beforeanyforeigntaxisdeducted.NB forforeignpensions onlyinclude90%ofthegrossamountreceived.
AddtotalsforParent/Carer1andParent/Carer2
FOROFFICEUSEONLY

Parent/Carer2

Pleasenotedeductionfromotherincomewhereappropriate. OVERALLTOTALPERANNUM

Section7(A):STUDENTDECLARATION

ThissectionmustbecompletedbythestudentapplyingforanEMAaward.
Ideclarethatalltheanswersgiveninthisformaretrue. Ihavereadtheguidanceandunderstandandacceptmyobligations. IunderstandthatifIgivefalseinformationorwithholdinformationmyEMAapplicationwillbecancelledand,if necessary,actionwillbetakentorecoveranymoneypaidtome. Iundertaketorefundanysumarisingfromanoverpaymentforanyreason. IunderstandthatifIdonotkeeptotheconditionsofmyLearningAgreement,paymentsmaybewithheld. IunderstandthatifIleaveschool,Iwillnotbeeligibleforanyfurtherpayments. IunderstandthatrelevantinformationmaybepassedontothirdpartieswithintheLocalAuthority. IgivepermissionfortheLocalAuthoritytoreleaseinformationrelatingtomyindependentstatustotheEMA Unit.

SignatureofApplicant Name(PRINT)

Date

Ifthestudentisunabletosignthisformduetoadditionalsupportneeds,pleaseleaveblankandtickbox provided.

Section7(B):PARENTAL/PARTNER/CARERDECLARATION Thissectionmustbecompletediftheapplicantisunder18yearsofageortheaward hasbeenassessedagainsttheincomeoftheapplicantsparent,spouseorcarer.

I/Wedeclarethattothebestofmy/ourknowledgeandbeliefalltheinformationgiven,inconnectionwiththis application,isfullandcorrectineveryrespect. I/WeundertaketoprovideanyadditionalinformationwhichmayberequiredbytheLocalAuthoritytoverify theparticularsgivenandalsotoinformtheLocalAuthorityimmediatelyofanyalterationintheseparticulars. I/WeundertaketoinformtheLocalAuthorityofanychangesinfinancialcircumstanceswhichmayaffectthe award. I/Weunderstandthatifmy/ourchilddoesnotkeeptotheconditionsoftheirLearningAgreement,payments maybewithheld. I/Weunderstandthatifmy/ourchildleavesschool,he/shewillnotbeentitledtoanyfurtherpayments. I/Weconsenttotheundertakingsignedbythestudentabove. Iam/Weareawarethatmy/ourchildisboundbytheconditionssetoutbytheEMAguidance. I/WegivepermissionfortheLocalAuthoritytoreleaseinformationrelatingtomy/ourhousehold circumstancestoEMAteamforproofofsingleoccupancy. Parent/Carer1 Date

Name(PRINT)

Parent/Carer2

Date

Name(PRINT) PleaseusetheChecklistonpage11toensureallrelevantdocumentationhasbeenprovided.

10

Section8:CHECKLIST
Wecanonlyacceptoriginaldocumentationtoaccompanytheapplicationform. Afirstclassstampmaynotbesufficientpostageforthisapplicationformandthiscouldresult inpaperworkbeingreturnedbythepostoffice. Listedbelowaredocumentsrequiredtosupportyourapplication(althoughnotallarerequired)
Documentationrequired(seebelow) Originalbirthcertificateorpassport(mustbeincludedwithapplication) Haveyouenclosedastampedaddressedenvelope(9x6insize)forpersonal documentstobereturned?Afirstclassstampmaynotbesufficientpostage Ifyouareanindependentstudent,PartCshouldbecompletedbytheDepartmentfor WorkandPensions(DWP) HMRevenue&CustomsTaxCreditAwardNotice(TCAN)TC602with2010/11income P60 Validweek52/month12payslip SAASorcollegeawardletter School/college/universityletterconfirmingenrolment StatementofearningsfromHMRevenue&Customsifparent(s)/carer(s)areemployed Ifparent(s)/carer(s)areselfemployedandarenotinreceiptofa(TCAN)TC602,SA302 oraccountantscertificate(seePartB)shouldbesubmitted Ifparent(s)/carer(s)receivebenefitsPartCmustbecompletedbyDepartmentforWork andPensions(DWP)oraP60Uorconfirmationlettermustbeincluded 2010P60supportingparent(s)/carer(s)occupationalpension Proofofguardianship,ifrequired,e.g.childbenefitletter Proofofloneparentstatus,e.g.counciltaxnoticeforperiodApril2010March2011 ProofthatyouareinthecareoftheLocalAuthority,ifapplicable P45isnecessary Otherdocumentsyoumayhavesupplied,pleasespecifyonAdditionalInformationpage 12 OtherdocumentationsrequiredasperSection5BHouseholdIncomecalculation Anydocumentationtosupportotherdependentchildren
Tickif enclosed Foroffice useonly

RETURNOFDOCUMENTS
Alldocumentswillbereturnedtothenamestatedonthereturnenvelope,unlessotherwisestatedon theAdditionalInformationsection(page12).

11

ADDITIONALINFORMATION

12

PartB1

Parent/Carer1

ACCOUNTANTSCERTIFICATEFORSELFEMPLOYEDCompletedbyaccountant
Ifbothparent(s)/carer(s)areselfemployed,eachisrequiredtocompletePartBseparately. NB:applicationmaybesubmittedwithPartBtofollow.

StudentName StudentDateofBirth NameofParent/Carer whoisSelfEmployed TradingName BusinessAddress / /

EstimatedProfitsforTradingYear20100/11
ADD

Chargesnotallowablefortaxpurposes
DEDUCT

CapitalAllowances
EQUALS

TAXABLEPROFITS

Pleaseprovideanydetailsofanyotherincomereceivedduringtradingyear2010/11: SelfEmployedParent/Carer1

Date
AccountantsName OfficeAddress

AccountantsSignature

AccountantsOfficialStamp

NB:AnSA302isstillrequiredinordertofinaliseanyaward.Thismayhavetobe requestedfromHMRevenue&Customs.

13

PartB2

Parent/Carer2

ACCOUNTANTSCERTIFICATEFORSELFEMPLOYEDCompletedbyaccountant
Ifbothparent(s)/carer(s)areselfemployed,eachisrequiredtocompletePartBseparately. NB:applicationmaybesubmittedwithPartBtofollow.

StudentName StudentDateofBirth NameofParent/Carer whoisSelfEmployed TradingName BusinessAddress

EstimatedProfitsforTradingYear2010/11
ADD

Chargesnotallowablefortaxpurposes
DEDUCT

CapitalAllowances
EQUALS

TAXABLEPROFITS

Pleaseprovideanydetailsofanyotherincomereceivedduringtradingyear2010/11: SelfEmployedParent/Carer2 Date AccountantsName OfficeAddress

AccountantsSignature

AccountantsOfficialStamp

NB:AnSA302isstillrequiredinordertofinaliseanyaward.Thismayhavetobe requestedfromHMRevenue&Customs.

14

PartC1
YourName YourNationalInsurancenumber Address

Parent/Carer1
StudentsName

CERTIFICATEOFBENEFITSRECEIVEDTobecompletedifPARENT/CARER1isinreceiptofbenefits

Tobecompletedbystudentsparent/carerbeforesubmittingtoDWP

IauthoriseDWPtogiveinformationrelatingtomybenefitsallowance Signature YoushouldnowtakethisformtoyourlocalDWPOfficeforcompletion. TobecompletedbytheDepartmentforWork&Pensionsforthedistrictinwhichthe parent/careris/wasregistered. Pleasecompletedetailsofbenefitsreceivedatanytimeduringtheyear6April2010to5April 2011.

Nameofadditionalperson(s)claimedforinadditionto above

Non Taxable Taxable

From: From: From: From: From: From: From: From: From: From: Other From: To: perweek TypeofBenefit: To: To: To: To: To: To: To: To: To: To: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit:

SignatureofManager/Clerk

Pleaseprintname Date DepartmentforWork&PensionsOffice

20

15

PartC2
Tobecompletedbystudentsparent/carerbeforesubmittingtoDWP

Parent/Carer2
StudentsName

CERTIFICATEOFBENEFITSRECEIVEDTobecompletedifPARENT/CARER2isinreceiptofbenefits

YourName YourNationalInsurancenumber Address

IauthoriseDWPtogiveinformationrelatingtomybenefitsallowance

Signature
YoushouldnowtakethisformtoyourlocalDWPOfficeforcompletion. TobecompletedbytheDepartmentforWork&Pensionsforthedistrictinwhichtheparent/careris/was registered. Pleasecompletedetailsofbenefitsreceivedatanytimeduringtheyear6April2010to5April2011.

Nameofadditionalperson(s)claimedforinaddition toabove

Non Taxable Taxable

From: From: From: From: From: From: From: From: From: From: Other From: To: perweek TypeofBenefit: To: To: To: To: To: To: To: To: To: To: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit: perweek TypeofBenefit:

SignatureofManager/Clerk

Pleaseprintname Date

20

DepartmentforWork&PensionsOffice

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