Social Welfare Services

Application form for BTE 1

Back to Education Programme Data Classification R

Back to Education Allowance (BTEA) (Second Level and Third Level Option),
Education, Training and Development Option.

You need a Personal Public Service Number (PPS No.) before you apply.

How to complete this application form.

• Please tear off this page and use as a guide to filling in this form.
• Please answer all questions. Incomplete forms will be returned and this may
delay your application.
• Please use BLACK ball point pen.
• Please use BLOCK LETTERS and place an X in the relevant boxes.
• You must send details of your college course with this application form. (If your
course has already started please give the reason for your late application).
• Your application may be sent to the Departments Activation Case officer. After
talking with you, they will determine the employment relevance of your chosen
course. A Deciding Officer will advise you if you satisfy the eligibility criteria for
the BTEA scheme. The Deciding Officer will also tell you what information and
documentation may be required. It is only at the end of this that your BTEA can
be decided.
• Applications for the Student Grant Scheme are processed by Student Universal
Support Ireland (SUSI). For more information, visit www.studentfinance.ie.
• It is not possible to receive the Back to Education Allowance (BTEA) and a
Student Grant maintenance at the same time. But you may be eligible for the
student services charge and/or tuition fees under the Student Grant scheme.
• Please note that a person who has recieved voluntary redundancy does not have
immediate access to BTEA.
• BTEA is categorised as a tax exempt payment.
Fill in all Parts that apply to you. When you have completed the form sign
declaration in Part 1.
If you need help to complete this form, please contact your local Citizens
Information Centre, your local Intreo Centre or your local Social Welfare Office.
For more information, visit www.welfare.ie.
 How to fill in first page of this form
To help us in processing your application:
• Print letters and numbers clearly.
• Use one box for each character (letter or number).
Please see example below.
1. Your PPS No.: 1 2 3 4 5 6 7 T
2. Title: (insert an ‘X’ or Mr. Mrs. X Ms. Other
specify)
3. Surname: M U R P H Y

4. First name(s): M A U R E E N
5. Your first name as it M A R Y
appears on your birth
certificate:
6. Birth surname: M C D E R M O T T

7. Your date of birth: 2 8 0 2 1 9 7 0

D D M M Y Y Y Y
8. Your mother’s birth K E L L Y
surname:
Contact Details
9. Your address: 1 N E W S T R E E T
O L D T O W N
D O N E G A L T O W N
County D O N E G A L Postcode

10. Your telephone O N E N U M B E R P E R B O X

number: MOBILE
O N E N U M B E R P E R B O X
LANDLINE
11. Your email O N E C H A R A C T E R P E R
address:

SAMPLE
B O X
 Social Welfare Services
Application form for BTE 1

Back to Education Programme Data Classification R

Part 1 Your own details

1. Your PPS No.:
2. Title: (insert an ‘X’ or Mr. Mrs. Ms. Other
specify)
3. Surname:

4. First name(s):
5. Your first name as it
appears on your birth
certificate:
6 . Birth surname:

7. Your date of birth:

D D M M Y Y Y Y
8. Your mother’s birth
surname:
Contact Details
9. Your address:

County Postcode

10. Your telephone number: MOBILE

LANDLINE

11. Your email address:

Declaration
I declare that the information given by me on this form is truthful and complete. I understand that if any
of the information I provide is untrue or misleading or if I fail to disclose any relevant information, that
I will be required to repay any payment I receive from the Department and that I may be prosecuted. I
undertake to immediately advise the Department of any change in my circumstances which may affect
my continued entitlement.
Date: 2 0
D D M M Y Y Y Y
Signature (not block letters)

Warning: If you make a false statement or withhold information, you may be

prosecuted leading to a fine, a prison term or both.
Part 1 continued Your own details
12. If your course has already started please outline the reason for the late application:

13. Please give details of all second level and third level courses you have completed and
year(s) you got each qualification:
Course 1
Type of course:

Year obtained:
Y Y Y Y

Qualification received:

Please specify award type: Full Major Minor Special purpose

Course 2
Type of course:

Year obtained:
Y Y Y Y

Qualification received:

Please specify award type: Full Major Minor Special purpose

Please attach a copy of all educational qualifications received to date.
Note: a separate sheet of paper can be used for more details if needed.

Examples of qualifications include Junior, Intermediate or Leaving Certificate, QQI courses to

level 6 courses or third level courses such as Degree, Honours Degree, H.Dip. Post Graduate
Diploma or Masters (MA) or qualifications in any other country. Qualifications Recognition, which
is part of Quality and Qualifications Ireland (QQI), facilitates the academic recognition of foreign
qualifications in Ireland.
For more information, visit www.qqi.ie or call 01 9058100.
You should provide written confirmation from this Authority of any qualifications received outside
of Ireland.
Part 1 continued Your own details
14. What work experience do you have? (please give details of previous employment, if any)
Employer’s name:

Employer’s address:

Job title:
Dates you worked there:
From:

To:
D D M M Y Y Y Y
Part 2 Your payment details
You can get your payment at a post office of your choice or direct to your current, deposit or
savings account in a financial institution. An account must be in your name or jointly held by
you. Please complete one option below.

Financial Institution
You will find the following details printed on statements from your
financial institution.
Name of financial institution:

Bank Identifier Code (BIC):

International Bank Account
Number (IBAN):

Name(s) of account holder(s):

Name 1:

Name 2 (if any):

Post Office
Please enter below the name and address of the post office where you wish to collect your
payment.

Post office name:

Post office address:

Part 3 Details of school or college
Please give details of the course you would like to do:
15.Name of school or college:
16.Address of school or
college:

17.What is the course: Second Level

Third Level Third Level Approved
Foundation undergraduate postgraduate
or Access
Please attach a copy of your course offer, CAO application or a copy of the web page
advertising the course.
18. Is the course: Full-time Part-time
19. Please state:
Title of course:

Level of qualification:
Award type: Full Major Minor Special purpose
Awarding body:
(example Hetac, Fetac,
Btec or College)
How long is the course: year(s)
Specify current year of First Second Third Fourth
course:
The start date of course:
D D M M Y Y Y Y
The end date of course:
D D M M Y Y Y Y
20.Have you previously attended this course of study?
Yes No
If ‘Yes’, please give details:

21.Have you previously attended a course equivalent to the same qualification?

Yes No
If ‘Yes’, please attach proof of the year you obtained this
qualification.
Note
If you have an entitlement to Back to Education, you will be asked to provide confirmation
from the Registrars/Admissions Office/Students Records Office of your school or college
that you are registered as a full-time day student. This letter should contain the starting and
finishing date of the course of study in the current academic year. You will only get the Back
to Education Allowance when you have given this information.
Part 4 Details of social welfare income
22. Please state why you consider this course of education will increase your re-employment
chances and is relevant to any progression plan agreed with the Department:

23. Are you getting a Social Yes No

Welfare payment?
24. If Yes, what payment are
you getting?
25. How long have you been months
getting this payment?
26. Name of office that pays
this payment:
27. If you are not getting a social welfare payment, are you?
A dependant on your spouse’s, civil partner’s or cohabitant’s
social welfare payment.
Signing for credits or forwarding medical certificates for credit
purposes.
28. What is your spouse’s, civil partner’s or cohabitant’s PPS No.:

29. Are you in receipt of an increase for your spouse, civil partner or cohabitant?
Yes No
If ‘Yes’, do you wish to continue to receive this increase?
Yes No

30. Are you in receipt of an increase for your dependant children?

Yes No
If ‘Yes, do you wish to continue to receive this increase?
Yes No
Part 5 Additional information
31.Have you taken part in SOLAS/FET VTOS Community Employment
any of the following: course (CE)/Rural Social Scheme
BTEA Internship

BTWEA, SOLAS/FET Job Initiative, Job Assist, STEA, Tús, ETB,

Solas, Springboard, JobPath.
Dates you spent on the above scheme or course:
From:

To:
D D M M Y Y Y Y
32.Are you getting any of the following secondary benefits?
Fuel Allowance Rent or Mortgage Interest Supplement

33.Have you recently been awarded Statutory Redundancy?

Yes No
If ‘Yes’, please attach a photocopy of your redundancy document (RP 50).

34.Have you applied for the Student Support Grant

Yes No

35. Please give details in the space provided of any additional information you may wish to
give about your application.
Part 6 Where to send your application
If you are getting any of Send this form together
the following payments: with the details of
college offer to:
• Jobseeker’s Benefit
• Jobseeker’s Allowance Your local Intreo Centre or
• Farm Assist Social Welfare Office

• Illness Benefit BTEA Section

Illness Benefit Section
Áras Mhic Dhiarmada
Store Street
Dublin 1
Telephone: 01 704 3294 or
01 704 3696

• Deserted Wife’s Benefit

Department of Employment
• Deserted Wife’s Allowance Affairs and Social Protection
Social Welfare Services
• Widow’s, Widower’s or Surviving Civil Partner’s
College Road
(Contributory) Pension
Sligo
• Widow’s, Widower’s or Surviving Civil Partner’s
Telephone: 071 915 7100
(Non-Contributory) Pension
LoCall: 1890 500 000
• Prisoner’s Wife’s Allowance
If you are calling from outside the
• Blind Pension Republic of Ireland please call
+ 353 71 915 7100

• Invalidity Pension Department of Employment

• Disability Allowance Affairs and Social Protection
Social Welfare Services
• Incapacity Supplement Ballinalee Road
• Longford
Carer’s Allowance

Telephone: 043 334 0000
LoCall: 1890 927 770
If you are calling from outside the
Republic of Ireland please call +
353 43 334 0000

Note: The rates charged for the use of 1890 (LoCall) numbers may vary among different
service providers.

Please remember to sign the Declaration in Part 1.

If you have any difficulty in filling in this form, please contact your local Citizens Information
Centre, your local Intreo Centre or your local Social Welfare Office.
 For official use only
To be completed by your local Intreo Centre or Social Welfare Office

Local Intreo or Social

Welfare Office code number:
Application for (please tick): Second Level Option Third Level Option

Post Grad Approved Education, Training & Development

Please state payment type: JA JB Credits Other

BTEA new claim 2018/19 Yes No
year?
Eligible age? Yes No

Statutory Redundancy? Yes No

Approved course? Yes No

Late claim? Yes No

Progression in Education? Yes No Note: Refer to Case Officer

Please state periods From: To: CT:

of Unemployment and
Cumulative Total: From: To: CT:

From: To: CT:

Please give details of periods spent on Solas, Community Employment, VTOS, BTEA,
BTWEA, Job Initiative, Job Assist, Tús, or National Internship.

From: To: CT:

Type: From: To: CT:

From: To: CT:

Total CT days for BTEA

Eligible for BTEA Yes No

Referral to Case Officer Yes No

Date: 2 0
D D M M Y Y Y Y
Signature of determining officer (not block letters)
 For official use only
To be completed by a case officer - recommendation for BTEA
BTEA recommended Yes No
If ‘Yes’, please outline recommendation reason(s):

If ‘No’, please give reason(s):

Other relevant information:

Official Intreo Stamp

Signature of case officer (not block letters)

Date: 2 0
D D M M Y Y Y Y

To be completed by a deciding officer in your local Intreo Centre

BTEA awarded BTEA refused

Decision issued: Yes No

Start date: 2 0
D D M M Y Y Y Y

ISTS code update Yes No

TLA updated Yes No

Date: 2 0
D D M M Y Y Y Y
Signature of deciding officer (not block letters)

Data Protection Statement

The Department of Employment Affairs and Social Protection administers Ireland’s social
protection system. Customers are required to provide personal data to determine eligibility
for relevant payments/benefits. Personal data may be exchanged with other Government
Departments/Agencies where provided for by law. Our data protection policy is available at
www.welfare.ie/dataprotection or in hard copy.
Explanations and terms used in this form are intended as a guide only and are not a legal interpretation.
30K 07-19 Edition: July 2019