Name
Street address
Post code
Home phone
E-mail address
DOB
Nationality Please supply a copy of your birth certificate
Name of employer
Company name
Company address
Position in company
Email address
Work phone
Signature
Date

If applicant is a non-member, appropriate membership must be applied for and membership fees paid before any grant is awarded.

In cases of special hardship membership may be granted as part of the award.

Membership number
Membership grade
For Applications outside of the UK, we need verification of your membership
Name of verifier
Email address of verifier
CILT/IOM Organisation (eg Kenya International Branch)
Position in CILT/IOM organisation
Signature of verifier
Date
Provide details of qualification you are applying for
Provide course details
Is application for professional or educational qualification?
Is course generic or sector-specific (e.g. related to handling of fresh foods or hazardous materials)?
Is qualification offered by CILT/IOM?
Name of course provider/ educational establishment
Address of course provider/education establishment
Are you already enrolled: Yes/No
Date of enrolment
Name of tutor
Email address of tutor
Position in establishment:
Signature of tutor
Date
How is qualification obtained? (e.g. by examination, dissertation, course work, external assessment, practical work.
Does course require full or part-time attendance or is it a distance learning course?
Location to be attended (if appropriate)
If full-time, is participation residential or daily attendance?
Course duration
Please state fees and costs in GBP Pounds Sterling
Course and examination fees
Cost of books and learning materials
Total amount requested
Contribution made by applicant's employer
Name of manager
Email address of manager
Position in establishment:
Signature of manager
Date
Funds provided by applicant

Please provide a current up to date CV to support your application

All recipients of grants/awards will be published on the ASPIRE website

The applicant hereby gives ASPIRE permission to use his/her name or likeness and case history in furtherance of the ASPIRE Careers Foundation programme.

Successful applicants agree to:

·  Return all funds not used for the qualification programme within 60 days of the date of the completion of the programme;

·  Furnish ASPIRE a report regarding course results and expenditure of funds associated with this programme, including appropriate documentary evidence and invoices, upon ASPIRE’s request.

Signature of applicant ______

Please print your name ______

Date completed form ______

1 V2 March 2014