PROTESTANT AID
74 Upper Leeson Street, Dublin 4
Telephone 01-6684298 Fax 01-660 3292
Email –
SECOND LEVEL EDUCATION EXPENSES APPLICATION - Office Ref No.
To be completed by School Principal
PARENTS/GUARDIAN NAME & ADDRESS………………………………………………………
……………………………………………………………………………………………………………
STUDENTS NAME(S) ………………………………………………………………………….
ACADEMIC YEAR 2016/17
PLEASE READ CAREFULLY
1. School Principal to complete Page 1 of application form. Page 2 to be completed by Parent /Guardian.
2. Photo copies of original application forms cannot be accepted.
3. This scheme applies to 1st year, Transition Year and 5th year students only.
4. Please ensure application is completed in full.
Geoff Scargill
Charitable Services Officer
Signature of School Principal ______
Name of School Principal (IN BLOCK CAPITAL) ______
Address______
______
Tel No ______
Email ______
BRIEF REPORT
TO BE COMPLETED BY PARENT/GUARDIAN
Please indicate below at “Source of Income/Benefit” whether income is from: -
A - Earned Income
B - Widow/Widower’s pension
C - Deserted Wife/Husband’s benefit
D - Invalidity Pension/Disability Allowance
E - Unemployment Assistance
F - One Parent Family Income
G- Child Benefit
H – Other
Applicants
Name
/Age
/Employed Yes/No
/Weekly Income €
/Source of Income/Benefit
Father
/ / / /Mother
/ / / /Dependants Name /
Age
/School
/Form
/Approx. combined cost of books, uniform, travel per annum €
Denomination
Signature of Parent/Guardian______
Date ______
Please return this page to the School Principal (if necessary in a sealed envelope)