APPLICATION for GRANT

Name ...................................................................................

Address ....................................................................................................................................................................................

Post Code .........................................................

Telephone No. .......................................................... Email address ...........................................................................................

Date of Birth.............................................................. Primary School attended ................................................................................................

From (Date) ............................... To (Date) .............................................. (You need to have attended for at least 2 years in order to qualify for a grant)

To help us verify this information please give your class Teacher's name: ....................................................................................

Name and Address of the University, College or other place of further education that you are/will be attending:

..................................................................................................................................................................................................................................................

Name of Course: .......................................................................................................................................................................................................................

Start date and Length of Course. .....................................................................................................................................................................

FOR UNIVERSITY STUDENTS PLEASE ENCLOSE A COPY OF PROOF OF STUDENT STATUS

FOR OTHER COURSES PLEASE ENCLOSE A COPY OF YOUR CLASS SCHEDULE OR OTHER DOCUMENT CONFIRMING YOUR COURSE OF STUDY.

Bank details (Grants will be paid by BACS).

Bank name .............................................................

Name on Account ..........................................................................

Sort Code ........................................... Account number ............................................................

Signed ................................................................................................... Date ...................................................

Please post this form and your proof of student status to: