Hardship Fund
Student ID:
Name:
Marital Status:
Ethnicity:
No of children:
Children’s Ages:
Address:
Home Phone:
Mobile:
Living Arrangements (please tick which applies)
Rent/Flatting
☐
Living with Parent/Guardian
☐
Living in Hostel/Boarding
☐
Own Home
☐
Living in Home with boarder
☐
Living with dependent children
☐
Studylink Advice/Assistance
☐
AUT Childcare Subsidy
☐
Budgeting Service
☐
Rent Arrears
☐
Financial Hardship
☐
Food Parcel
☐
Financial Assistance Fund
☐
Other (please state) _______________________________
☐
Living in AUT Hostel
☐
Service Required:
Checklist:
Are you a domestic student
Yes
☐
No
☐
Are you Studying Full-time
Yes
☐
No
☐
Fees Paid
Yes
☐
No
☐
Do you have evidence of your situation
Yes
☐
No
☐
Have you taken Studylink course related costs
Yes
☐
No
☐
How did you hear about our service (please tick which applies)
Advisor
☐
Class talk
☐
Faculty Staff
☐
Friend
☐
Health & Counselling
☐
Website Poster
☐
Other (please state) __________________
☐
Documents supplied
Bank Statement
☐
Debts/Hire Purchases
☐
☐
Quotes
Other
☐
Please note you will be required to complete a budget with a Student Hub Advisor (Financial)
Authorisation
In accordance with the Privacy Act 1993, Principles 3(b) and 11(d) I understand that this information is to be recorded. I t has also been explained
to me that my file may be inspected by a representative of our contract provider or by a representative of the New Zealand Federation of Family
Budgeting Services Inc for the purposes of a quality review of this service.
I HEREBY AUTHORISE Student Hub Advisors (Financial) to contact: Studylink, Student Loan Management, WINZ, my bank and to access creditor
information where applicable.
I understand that making a false declaration is an offence under the Crimes Act 1961. (Please sign declaration below)
Student Signature:
Date:
Please explain why you need assistance today:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
STAFF USE ONLY
Enrolment Checked

Bank Statement Provided

Academic Results Checked

Debts/Hire Purchases Provided

Fee Payment Checked

Quotes Provided

Registry Flags Checked

Other Applicable Documents Provided

Assistance
Ref. Number
Details
Amount
Food Voucher
Food Parcel
Bus/Train/Shuttle Ticket
Petrol Voucher
Meal Voucher
Other (ICD, Claim Form)
TOTAL
Students Signature:
Advisor notes:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Assistance Provided:
Budgeting

Childcare

Claim Form/ICD

Financial Advice

Financial Assistance Fund

Food Parcel

Studylink/WINZ

Vouchers


SFS Database

Records Entered On:
SRM
Student Hub Advisor
(Financial) Signature:
Date:
Please explain why you need assistance today:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
STAFF USE ONLY
Enrolment Checked

Bank Statement Provided

Academic Results Checked

Debts/Hire Purchases Provided

Fee Payment Checked

Quotes Provided

Registry Flags Checked

Other Applicable Documents Provided

Assistance
Ref. Number
Details
Amount
Food Voucher
Food Parcel
Bus/Train/Shuttle Ticket
Petrol Voucher
Meal Voucher
Other (ICD, Claim Form)
TOTAL
Students Signature:
Advisor notes:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Assistance Provided:
Budgeting

Childcare

Claim Form/ICD

Financial Advice

Financial Assistance Fund

Food Parcel

Studylink/WINZ

Vouchers


SFS Database

Records Entered On:
SRM
Student Hub Advisor
(Financial) Signature:
Date:
Please explain why you need assistance today:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
STAFF USE ONLY
Enrolment Checked

Bank Statement Provided

Academic Results Checked

Debts/Hire Purchases Provided

Fee Payment Checked

Quotes Provided

Registry Flags Checked

Other Applicable Documents Provided

Assistance
Ref. Number
Details
Amount
Food Voucher
Food Parcel
Bus/Train/Shuttle Ticket
Petrol Voucher
Meal Voucher
Other (ICD, Claim Form)
TOTAL
Students Signature:
Advisor notes:
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
Assistance Provided:
Budgeting

Childcare

Claim Form/ICD

Financial Advice

Financial Assistance Fund

Food Parcel

Studylink/WINZ

Vouchers


SFS Database

Records Entered On:
SRM
Student Hub Advisor
(Financial) Signature:
Date: