Wrtc Form

WOMEN’S RIGHT TO CHOOSE FUND 2009/2010 WHO CAN APPLY The Women Right to Choose Fund is open to students registered at the LSE. Unfortunately we do not accept applications from private individuals (non-registered students). PURPOSE OF THE FUND The fund is intended to assist expectant students to provide pre birth cost before the child is born or cost for termination. If you choose to proceed with the pregnancy, we will contribute to one off costs such as a buggy, cot etc. If you choose to terminate your pregnancy, we will be willing to contribute towards the cost if it is reasonable to do so, and you are unable to access the NHS service/treatment. Please note that the maximum award £500 per student per academic year. USE OF FUNDS AWARDED Please note that the funds awarded are given on the basis that it will be used solely for the purpose for which it was given. Should the Student’s Union become aware that the funds are used for any other purpose we will seek to recover the full sum. CONFIDENTIALITY The application is assessed by staff of the Advice Centre and, if subjected to reconsideration, by the reconsideration Panel only. The information that you provide on the application form and during the interview will be treated as confidential and not be shared with any other persons unless you give us permission to discuss the application with a relevant 3rd party, where necessary. Full details of our Confidentiality Policy detailing how your information will be treated can be obtained upon request.

WHAT YOU HAVE TO DO 1

Please carefully read the guide to filling in the form enclosed before you complete your application form. The following documents must be returned to room E297; 1. 2. 3. 4.

Completed Form 3 months recent bank statements Copy of current certificate of registration Additional supporting documents including medical evidence.

You must return your form in person so that an interview can be arranged for you. WHAT HAPPENS AFTER APPLICATION IS SUBMITTED When the application and supporting documents are submitted, an appointment will be agreed for you to be interviewed by an Adviser. The interview will take the form of a short discussion with an adviser. Information shared at the meeting is kept entirely confidential. If you feel uncomfortable about discussing your situation at interview please talk to an adviser at the Advice Centre about your concerns. If you need to change your interview time please let us know as soon as possible. (Room E297 or Tel: 020-7955-7145 or E-mail: [email protected] AFTER INTERVIEW An Adviser will do the initial review of the application, and, after being satisfied that all relevant documentation is in place, will pass the application to the ACC Panel for consideration. DECISIONS OF THE PANEL The Panel meets twice a week to consider applications. Within 3 working days of the applications being submitted to the Panel, you will be notified of a decision. If granted, the awarded sum is paid directly to the applicant in the form of a cheque. The cheque would normally take an additional five working days to produce. RECONSIDERATION OF DECISIONS If you are not happy with the decision of the Panel, then you may make a written request to the Manager of the Advice and Counselling Centre for the matter to be reconsidered.

LSE STUDENTS’ UNION WRTC FUND APPLICATION FORM 2

Personal Details 1. Surname: __________________________________________________________ 2.Firstname: _________________________________________________________ 3a: LSE Registration number: _____________________________________________ b: Home or Overseas for fees: ___________________________________________ 4. Term time Address: ___________________________________________________ _____________________________________________________________________ 5. Telephone number:____________________________________________________ 6. E-mail Address: ______________________________________________________ 7. Age: _____________

8. Male/Female

9. Do you have a husband/wife/partner? YES/NO 10. If yes, is he/she with you in London?

YES/NO

11.If yes, what is your partner’s net annual income? ______ 12.How many dependent children are with you in London? ______ 13. What are their ages ___________ Course details 14. Course Title: _______________________________________________________ 15. Undergraduate/Postgraduate

16. Full-time/Part-time

17. How long does the course last? _________ 18. What year of the course are you in? _______ Academic year dates are the date you registered until the end of your academic year (normally end of June or end of Sept.) Please work out the number of weeks this covers normally 39 or 52 (take away the number of weeks when you are not paying living costs in London e.g. vacations and/ or add any extra weeks before the start of the course for presessional English course or looking for accommodation).

Please answer questions in this page if your application is for termination. GP details; 3

Name ……………………………………………………………………………. Address………………………………………………………………………….. Telephone:………………………………………………………………………. Fax……………………………………………………………………………….. Email……………………………………………………………………………… Have you had counselling? When is the termination due? How many weeks is the pregnancy? Do you have a letter of medical support? Do you have documentary proof of pregnancy? Which hospital do you intend to do the procedure? Address Telephone Contact Cost: Medication ……………. Consultation ………….. Other…………………….. Total…………………….. For students that prefer not to use National Health Service (NHS), we suggest they consider using the service of Marie Stopes. Please note the information above is taken to enable the SU Advice Centre the assess application. It will be treated as confidential. If for any reason we need to contact a third party, we will inform you first before making any contact. Please use the space below to address any relevant issue not covered in the application and which the SU Advice Centre may need to know in making award. This may include Pre Birth Cost. 4