UK registered charity number 1088594
Personal Application Form
Please print or type the information requested below
I. Personal & professional details
Name ______Male/Female
Date of birth ______
Home address ______
______
Current address if different ______
______
Telephone ______Email ______
If you have lived in Bromsgrove for less than one year, please provide your parents’ address in Bromsgrove and how long they have lived there:
______
______
What is your present monthly income including part-time work? £ ______
On a separate sheet please provide a brief summary of your education, qualifications, work experience and career so far, with dates.
II. Educational institution at which you are currently registered
Name ______
Address ______
______
Registration/Enrolment No. (if applicable) ______
Telephone ______Fax ______Email ______
What is your present position? ______
Please note:
· that applicants should be registered currently as a student at an institution of further or higher education, and
· that funding is not normally given towards the standard costs of education for e.g. NVQs, A or AS levels, undergraduate or postgraduate courses.
· In exceptional circumstances, one-off small grants may be paid towards specific items, e.g. books or special equipment needed for vocational courses, or in cases of genuine financial hardship.
III. Information on your application
Please give a brief account of the purpose of your application in either A, B, C or D below with an indication of how this would benefit you.
A. If it is proposed to use the award to purchase subject-specific equipment which will facilitate your education please indicate:
1. Type of equipment
______
2. What will it enable you to do?
______
______
3. Estimated costs ______
______
B. If it is proposed to use the award for a future travel-related project please give:
1. Full details of travel plans, planned visits etc, including dates:
______
______
______
______
______
______
2. Please list any correspondence or prospectuses you have regarding your proposed travel (and attach details):
______
______
______
______
______
C. If the proposal is for any other purpose, please give details here:
______
______
______
______
NB: (a) The proposal should relate to your educational objectives. (b) Awards are not normally made to cover the standard costs of education.
IV. Information on Financing
1. What is the estimated cost of your plans? Please give details of e.g. travel costs, accommodation, fees, equipment costs:
______
______
2. Have you applied to any other body for financial assistance? Yes [ ] No [ ]
If yes, please give details and the result of the application:
______
______
3. If you are employed, will your employer contribute to your costs? Yes [ ] No [ ] If yes, how much? £ ______
4. Will you be able to contribute to the cost of the project from your own funds?
Yes [ ] No [ ] If yes, how much? £ ______
V. Other Information
1. Please give here or on an additional sheet of paper any other information which you consider relevant to your application and which might assist the Trustees in making their decision:
______
______
______
______
2. Please submit an academic reference in support of your application.
Applicant’s signature Date
When you have completed this form, please send nine copies to:
Joan Holland, The Administrator, The Bromsgrove Institute Trust,
Thomas Horton LLP, Strand House, 70 The Strand, Bromsgrove, Worcs, B61 8DQ
Email:
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