Laptop Lending Scheme Application Form

Personal Information

Eircode: (You can find your Eircode at https://finder.eircode.ie/#/)

General Information

Please tick boxes as appropriate (Applicants must belong to one of these categories to be eligible to apply for this Laptop Scheme).

(Proof of SUSI award/Social welfare payment/personal statement & P21 must be supplied)

Access Target Groups: (tick as appropriate)

Please tick all of the following Access Target Groups which apply to you: (Proof of belonging to target groups must be supplied)*

I have applied to MIC as follows: (tick as appropriate):

Digital Information

What device(s) are you going use to access your teaching and assessment materials during this academic year? Please indicate all that apply:

Do you share devices with others?

Personal Statement

If there is any information that you feel should be taken into account when your application is considered, you should include it here. There is a maximum of 250 words in this section. You should consider the following:

• Your personal and/or family circumstances.

• How the Scheme will help you achieve your goals and ambitions?

• What barriers have you faced in achieving your goals and ambitions?

• Have you/your family experienced severe financial hardship/change in circumstances?

Income based eligibility:

• All applicants must provide a confirmation of gross household income via P21 or Notice of Assessment for self (and spouse/partner or parent(s) or guardian(s), if applicable) for 2020 and/or Statement of total household DEASP benefits received in 2020.
• If applying for the scheme as a SUSI applicant, you must submit copy of the SUSI letter/email for 2021/22. You must include your reckonable income page with your approval page.
• Social Welfare Payment: If applying for the scheme as a social welfare recipient, you must submit evidence of your weekly payment (amount/type).

*Access Target Groups:

Proof of belonging to target groups must be provided, such as: a letter from TUSLA, Travellers Group, DSP Lone Parent/Disability, legal status in country or letter from refugee support groups, results from FE/PLC programme etc.

Privacy Notice: MIC values your privacy and recognises the need to process your personal data in a fair, transparent and lawful manner in accordance with the legal obligations as set out in the General Data Protection Regulation (GDPR) and the Irish Data Protection Act 2018.

Declaration: I certify that the information provided on this form is true, complete and accurate. I also agree that the information I provide may be used for the purposes of reporting on the laptop lending scheme to the HEA and Department of Education and Skills.

Please do not forward your application until it is complete with ALL the necessary supporting documentation.