Add more rows as appropriate… Financial Indicators* *Applicants who accessed the Diploma in Legal Studies at The Honorable Society of King’s Inns as a mature student without a third level degree are required to demonstrate eligibility for The Denham Fellowship against a combination of social and financial indicators. Financial indicators will assess for example the applicant’s income from paid employment (including self-employment) and income from the Department of Social Protection. Where an applicant is residing with his/her spouse/partner or parent(s), financial indicators will also assess the income of the spouse/partner or parent(s). Income from paid employment (including self-employment) Please provide particulars of income from paid employment (including self-employment) where applicable. If you are residing with spouse/partner or parent(s), please give details of their income. Complete as appropriate Estimated income for the year ended 31 December 2016 Documentary Evidence Required Self Spouse/Partner Father Mother Occupation (be as specific as possible) N/A Income from employment e.g. PAYE – salary, wages, fees etc. P60 and P21 Income from pension (from former employer or pension scheme) Notice of Assessments and Accounts Income from P60 and P21 Income from land: profits from farming activities Notice of Assessments and Accounts
Income from any other source. (Please specify) Relevant evidence Income from Department of Social Protection (DSP) Please provide particulars of income from the Department of Social Protection (DSP) where applicable. (Excludes Child Benefit). If you are residing with spouse/partner or parent(s), please give details of their income. Complete as appropriate Estimated income for the year ended 31 December 2016 Documentary Evidence Required Self Spouse/Partner Father Mother Current or most recent occupation (be as specific as possible) N/A DSP – Jobseekers Benefit P21 and Social Welfare Statement DSP – Jobseekers Allowance P21 and Social Welfare Statement DSP – Jobseekers Transitional payment (JST) P21 and Social Welfare Statement DSP – Supplementary Welfare Allowance P21 and Social Welfare Statement DSP – Pension Payment (please specify) P21 and Social Welfare Statement DSP – Rent Supplement P21 and Social Welfare Statement DSP – Mortgage Interest Supplement P21 and Social Welfare Statement
DSP – Illness Benefit P21 and Social Welfare Statement DSP – Disability Allowance P21 and Social Welfare Statement DSP – Partial Capacity Benefit P21 and Social Welfare Statement DSP payment (please specify) P21 and Social Welfare Statement Medical Card/GP Visit Card Do you possess a medical card/GP Visit Card valid on 31 December 2016? Yes No If yes, please specify and provide the number. Self Medical Card Card No. _________ GP Visit Card Card No. _________ If you are residing with a parent(s) and where your parent(s) is in possession of a means-tested Medical Card/GP Visit Card, please specify and provide the number in the relevant section below. Father Mother Medical Card Card No. _________ GP Visit Card Card No. _________ My father does not possess a Medical Card / GP Visit Card Medical Card Card No. _________ GP Visit Card Card No. _________ My mother does not possess a Medical Card / GP Card Applicant Status* Are you an EU National? OR Have you been granted Refugee Status? Yes No Yes Year Granted: No Do you require an education visa to study in Ireland? Yes No