David Butler Bursary Application Form 2015

David Butler Bursary Application Form 2015

Category A

IMPORTANT: This Word version is only to assist preparation of your application. Only applications submitted via the online form will be considered.

This category is open to applicants registering onto a CIH recognised training or education course, including CIH short courses.

Before completing your application form please ensure you have read the eligibility criteria and guidance given.

Please ensure that all sections and questions relating to your circumstances are fully completed to provide the information required to assess your application. Please be aware that the maximum number of words for the open ended questions is 500 words approx/3500 characters with spaces.

There are certain fields which are mandatory (marked with a *) and your application will not submit if they are not completed.

Please note that applications deemed to be incomplete and/or inaccurate applications will not be considered by the assessment panel.

Closing date for applications is noon on Tuesday 7 April 2015 and no further applications will be accepted after this time.

SECTION ONE: About you

1. About you

Title*

First Name*

Last Name*

2. Your contact details

NB Please note that email will be the main point of contact.

Home address*

Town*

County*

Postcode*

Country*

Telephone Number*

Email Address*

Please confirm email address*

3. Are you a current CIH Member?

Yes

SECTION TWO: About your employment status

4. How would you describe your employment status?

A - Permanent paid employment - Full Time

B - Permanent paid employment - Part Time

C - Temporary paid employment - Full time

D - Temporary paid employment - Part Time

E - Unemployed - doing voluntary work

F - Unemployed - no voluntary work

Please note: All applicants who are either employed or doing a voluntary role must complete Part A, and any applicant who is in a voluntary role or unemployed must complete Part B.

PART A - Job Details

5. What is your job title?

Please indicate length of time in current post:

up to 6 months

6 - 12 months

12 - 24 months

over 24 months

Company

Address 1

Address 2

City/Town

Postcode

PART B - Voluntary work/ Placement and Benefit Details

6. If you are currently unemployed are you in receipt of any means tested benefits?

If YES please state which benefits below:

7. If you have indicated that you are undertaking a voluntary placement, please provide details such as organisation, length of placement/experience and an outline of functions and experience:

SECTION THREE: About your application

8. Please confirm you are applying for Category A funding *

Education and Training Category up to £1,500

9. What is the name of the CIH accredited training or education course? *

10. Is this course:

Full time

Part time

11. Please provide the name of the education establishment/distance learning centre providing the course or training?

12. Have you already commenced the course?

Yes

13. When did/will the course start? (MM/YY)

NB. If applying for a CIH short course and the dates for the next intake have not yet been confirmed/published please also indicate this here.

14. If the course has yet to commence, has your eligibility been confirmed?

Yes

Not applicable

NB. Applicants are asked to have checked their eligibility before completing a bursary application form.

15. How long does the course or training last?

16. How much are the course fees in 2015/2016?

17. Please state how much funding you are applying for? (Maximum £1,500)

18. If the course that you are applying for is longer than one year in duration please indicate how you plan to fund the remaining years of your course.

19. Do you hold any other housing qualifications? If YES, please give details of which qualifications and when achieved

20. Is your employer providing any funding, now or in the future? If YES please state the amount. If NO please state the reason your employer is not providing funding.

NB. Please also complete if you are carrying out a voluntary role with an organisation

21. Is your employer willing to provide financial funding support for you next year?

NB. Please also complete if you are carrying out a voluntary role with an organisation

22. Is anyone else supporting you with your funding? If YES please state the organisation and amount. If NO have you sought financial support elsewhere?

NB. Please ensure you indicate if you are in receipt of any grants or loans to support your studies

23. Are you awaiting the outcome of any other requests for funding? If YES please state the organisation and amount.

24. Have you received an education or training grant from the Chartered Institute of Housing before? If YES please give details

25. Personal statement of approximately 500 words

This is your opportunity to tell us why you want to study your chosen course; why you are applying for financial support; and why you have a particular interest in a career in housing. Any other matters that might have a bearing on your studies, which you would wish to bring to the attention of the Bursary Panel may also be provided here. *

Thank you for completing the David Butler Bursary 2015 application form. Before submitting the application please continue to complete the CIH Equality and Diversity Monitoring form. The information received will remain totally confidential and is not included in the information provided to the short listing panel.

We recognise that some people may regard some of this information as personal and we have, therefore, included an option in most questions for 'prefer not to say'. You do not have to complete all of this form but it will help us improve our services if you can complete as much as possible and submit the form.

CIH Equality and Diversity Monitoring

The CIH is committed to ensuring that its services are accessible to everyone regardless of age, disability, gender (including transgender), race, religion or belief, sex or sexual orientation. The information you give on this form will help us comply with our policy of ensuring equality in our services to you.

Your age

A. What is your date of birth?

Your disability

The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which has a substantial and long term effect (ie has lasted or is expected to last at least 12 months) on the person's ability to carry out normal day-to-day activities.

B. Do you consider yourself to have a disability according to the terms given in the Equality Act 2010?

Yes

C. If you have answered Yes, please indicate the type of impairment. Please tick all that apply. If your disability does not fit any of these types, please mark 'Other'.

· Physical/mobility impairment, such as difficulty using your arms or mobility issues which require you to use a wheelchair or crutches

· Visual impairment, such as being blind or having serious visual impairments

· Hearing impairment, such as being deaf or having serious hearing impairments

· Mental health condition, such as Depression or Schizophrenia

· Learning disability/difficulty, such as Down's Syndrome or Dyslexia or a cognitive impairment such as Autistic Spectrum Disorder

· Long-standing illness or helalth condition, such as Cancer, HIV, Diabetes, Chronic Heart Disease or Epilepsy

· Other, please specify below

Your ethnic group (These are based on the Census 2011 categories, and are listed alphabetically)

D. Asian, Asian British, Asian English, Asian Scottish, Asian Welsh or Asian Irish

Indian

Bangladeshi

Pakistani

Other Asian, please specify below

E. Black, Black British, Black English, Black Scottish, Black Welsh or Black Irish

Caribbean

African

Other Black, please specify below

F. Chinese, Chinese British, Chinese English, Chinese Scottish, Chinese Welsh or Chinese Irish

Chinese

Other Chinese, please specify below

G. Mixed

White & Black African

White & Black Caribbean

White & Asian

Any other mixed/multiple ethnic background, please specify below

H. Other

Arab

Prefer not to say

Other, please specify below

I. White

White/Welsh/Scottish/Northern Irish/British

Irish

Gypsy or Irish Traveller

Any other White, please specify below

Your gender

J. What is your gender?

Male

Female

Prefer not to say

K. Do you consider yourself to be Transgender?

Yes

Prefer not to say

Other, please specify below

Your religion or belief

L. What is your religion or belief?

Buddhism

Christianity

Hinduism

Judaism

Islam

Sikhism

Prefer not to say

No religion

Other, please specify below

Your sexual orientation

M. What is your sexual orientation?

Bisexual

Gay Man

Gay Woman (Lesbian)

Heterosexual/straight

Prefer not to say

Other, please specify below if you wish

Thank you for completing the David Butler Bursary 2015 application form. You will be contacted in early July with the outcome of your submission.

Please select Submit for your application to be assessed.