Parent 2/Guardian 2 Name: ___

Please do not alter the year for which information is required on this form. Total Social Welfare Income on all social welfare schemes* previously paid to this PPS number in the year 2025?

Total Social Welfare Income on all social welfare schemes* previously paid to this PPS number in the year 2025?

In receipt of means-tested social assistance payment(s) for at least 26 weeks or 6 months in the year 2025? YES

YES NO

Name of Payment(s): ___

Payment 1:

Payment 2:

*Excluding Child Benefit and certain supplements paid under the Supplementary Welfare Allowance schemes.

Additional Payment Information

1. 1. Is there an Adult Dependant on payments listed on this form? YES NO

YES YES

NO

YES

NO

Name of Adult Dependant:

2. Are means deducted for payments?

If yes, please enter amount of weekly means deducted

Weekly means deducted for Parent 1/Guardian 1 in 2025

Weekly means deducted for Parent 2/Guardian 2 in 2025

All forms must be completed, signed and stamped by a DSP official. Forms that are not signed and stamped are invalid.

Name of DSP Official (BLOCK CAPITALS):

Signature of DSP Official

D D M M Y Y Y Y

Date:

DSP Official Stamp

HEAR is a college and university admissions scheme for school leavers, resident in the Republic of Ireland, who are under represented at Higher Education due to their socio-economic background.