Form SAF1
STUDENT ASSISTANCE FUND
1.
STUDENT DETAILS
Student Name (as it appears on your student I.D. Card: (Use Block Capitals):
____ _______________________
________
Student ID:
______________________________________
Email Address:
Mobile Phone No:
2.
RECEIPTS:
All applications must be accompanied by receipts for the amount allocated to you. Please fill out the receipts
form below (in the same manner as shown in the example).
EXAMPLE
Childcare
Receipt
1
2
Total
Amount
400.00
400.00
800.00
Rent
Receipt
1
2
Total
Food
Amount Receipt
350
1
350
2
700
Total
Amount
20
50
70
RECEIPTS FORM (cannot be accepted if incomplete – see above example):
Childcare
Receipt
1
2
3
4
5
Total
Food
Receipt
1
2
3
4
5
Total
Rent
Amount
Amount
Receipt Amount
Oil/Gas
Receipt
1
2
3
4
5
Total
Amount
Books/ Academic
Materials
Receipt Amount
1
2
3
4
5
Total
Transport
Electricity
Receipt Amount
1
2
3
4
5
Total
Receipt
Medical / Dental
Receipt
Amount
1
2
3
4
5
Total
Amount
Other Exceptional
Receipt Amount
1
2
3
4
5
Total
CONFIRMATORY DOCUMENTATION REQUIRED:
Please provide confirmatory documentation as applicable to you (choose from the list below and tick the
relevant boxes:
Confirmation of parents/guardians income (P60, P21 or payslip)
Confirmation of applicants income (P60, P21 or payslip)
Confirmation of Social Welfare payment to parents/guardians
Confirmation of Social Welfare payment to applicants
Details of Grant
Verification of Mortgage
Bank Statement showing a least 6 weeks of current transactions
Copy of Medical Card
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CONFIRMATION
I confirm that I have submitted the online HEA Profile Data form and that all the information given is true,
complete and accurate in every particular and that assistance from other sources has not been received for
the stated purpose/service, which is the subject of this application. By signing this form I am consenting to
the amount of
being transferred to by Bank Account (details of which I have supplied on
the HEA Profile Data Form.
SIGNED:
___________________________ DATE:
___________________________
Managing money and getting the most out the money we have is a skill. Using a budget tool like that provided
by MABS at http://www.mabs.ie/budgeting-tool/ is very useful. And if you want more advice in making your
money stretch and living on a tight budget, you can make an appointment to meet with Cindy Dring, Student
Financial Adviser and Health Promotion Officer, Student Services, tel 492364 or email
studentfinancialadvice@nuigalway.ie