Ema Application Form

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student finance wales

EMA
Education Maintenance Allowance Application Form for 2012/13

www.studentfinancewales.co.uk/ema

SFW/EMA/F/V1213

how to complete this application form
Where you see this sign Where you see this sign
Student

you should complete the section. your parent(s)/guardian(s) or partner must complete the section.

Parent/Guardian/Partner

Student
You need to: Complete sections 1 to 8 of this form
All EMA payments will be paid into a bank or building society account in your name. If you haven't already got a bank account you should open one while you apply for EMA.

Sign your agreement in Section 8 You must send your original birth or adoption certificate and proof of address

If you forget to send your evidence, this will delay your EMA application.

Parent(s)/guardian(s) or partner
You need to: Complete sections 9 and 10 of this form
If you aren't financially dependent on your parent(s) or guardian(s) we need details of your income, and of your partner (if applicable).

Sign your agreement in Section 11 Send your original financial evidence for 2011–12 tax year

The guidance notes list the types of financial evidence you can send.

remember:
• • You must send in original evidence to support your application when you see this icon Read the guidance notes when you see this icon

e

n

If you need further information: • The little book of EMA (available from schools/colleges, Careers Wales or to download from www.studentfinancewales.co.uk/ema) • go to www.studentfinancewales.co.uk/ema; or • email EMAWales@slc.co.uk; or • call us on 0845 602 8845; or • by textphone 0845 603 1693. You can order forms and guides in Braille, large print or audio by emailing us your name and address along with your message about what format you require to brailleandlargefonts@slc.co.uk or you can telephone us on 0141 243 3686. Please note, the email address can only deal with requests for alternative formats of forms and guides. 2 SFW/EMA/F/V1213

INTERNAL REFERENCE NUMBER: (For internal use only)

Student

section 1 your details

If you are an existing EMA student, please provide your Customer Reference Number:

Q1.

Title

n

Mr

Mrs

Miss

Other

First name(s) Surname/Family name Sex Date of birth In which town or city were you born? Male DAY

Female
MONTH YEAR

e

Send your original birth or adoption certificate to prove your identity.

Q2.

Home address

n

!

You must usually live in Wales to be eligible for EMA.

Postcode Home telephone number Mobile telephone number (We may contact you by text message) Email address

e

Send proof of address in Wales. This can be a Tax Credit Award Notification (TCAN) or a household bill (like a gas or electricity bill dated within the last three months). You can see an example TCAN on page 10 of the guidance notes.

SFW/EMA/F/V1213

3

Student

section 1 your details

security details
Q3a. Please provide a ‘Secret Answer’. It is important you make your Secret Answer easy to remember as we will ask you to confirm this whenever you call us. Q3b. Please provide a ‘hint’ question to remind you of your Secret Answer. For example, if you chose ‘Superman’ as your Secret Answer then your ‘hint’ question could be ‘What is the name of my favourite superhero?’ If you ever forget your Secret Answer we will ask you this ‘hint’ question to help you remember it.

Student

section 2 your school or college details

Please enter the details of the school or college where you intend to study from September 2012. If you don’t know where you will be studying from September 2012, just give the details of the school or college you are currently attending and you can let us know where you will be studying later.

Q1.

Name of school or college Campus

Q2.

School or college address

Postcode

4

SFW/EMA/F/V1213

Student

section 3 your nationality and residency details n

Tick the...
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