Date of Birth: I wish to apply for Medium priority funding under the following criteria (please delete as appropriate): My gross household income is below £20,000 I was in receipt of Free School Meals in Year 11 My household is in receipt of other means tested benefits I wish to apply for support towards: Specific weekly need (i.e. transport to school, Cost per week meals) Individual item needs (i.e. books, equipment, Cost UCAS fee, school trips, university visits) I attach to this form the following evidence to support my application (please specify below). I will be able to provide receipts for the above. I confirm that the details on this application and the evidence provided are true and accurate. Signed (Student) Date ……………………………………………………… ……………. Signed (Parent/Carer) Date ………………………………………………. ……………. Date application received Date Reviewed by Committee …........... ……………… Outcome: This form to be handed to the Finance Office as soon as possible. APPENDIX 3 Application for low priority funding – This should be completed in addition to the main application form and should be submitted with appropriate evidence. Full Name: Form: Date of Birth:
Date of Birth: I wish to apply for Medium priority funding under the following criteria (please delete as appropriate): My gross household income is below £20,000 I was in receipt of Free School Meals in Year 11 My household is in receipt of other means tested benefits I wish to apply for support towards: Specific weekly need (i.e. transport to school, meals) Cost per week Individual item needs (i.e. books, equipment, UCAS fee, school trips, university visits) Cost I attach to this form the following evidence to support my application (please specify below). I will be able to provide receipts for the above. I confirm that the details on this application and the evidence provided are true and accurate. Signed (Student) ……………………………………………………… Date ……………. Signed (Parent/Carer) ………………………………………………. Date ……………. Date application received …........... Date Reviewed by Committee ……………… Outcome: This form to be handed to the Finance Office as soon as possible. APPENDIX 3 – Application for low priority funding This should be completed in addition to the main application form and should be submitted with appropriate evidence. Full Name: Form: Date of Birth:
Elutec_16-19-Bursary-Fund-application-form.docx