Please read the GUIDANCE NOTES at the end of the form before you start to complete details.
Wherever possible please fill in this form using a computer and email back to
Or complete by hand and post to
Middleton Educational Trust
c/o 94 Whalley Road
Clayton-le-moors
ACCRINGTON
BB5 5DY
This form is private and confidential - your application data (together with any decision) will be held in writing for a period of six years and will not be shared with anyone else* unless required by law or to verify if the applicant has applied elsewhere for similar purposes. Please tick if you agree. / YES –I AGREE.
TICK HERE
*Are you an ex-member of the Armed Forces? Rochdale Council has in place an Armed Forces Community Covenant, a statement of mutual support between the civilian community and its local armed forces community, including families and veterans. If you agree, your contact details ONLY will be shared with Rochdale Council for possible referral onto other supporting agencies.
Please tick if you agree. / YES –I AM AN EX-MEMBER OF THE ARMED FORCES AND I AGREE.
TICK HERE
PLEASE NOTE THAT FUNDS ARE VERY LIMITED AND NOT ALL APPLICATIONS FOR FUNDING ARE APPROVED FOR SUPPORT – SO PLEASE TRY TO BE CLEAR ON YOUR NEED AND REASONS WHY YOU ARE SEEKING SUPPORT, TO HELP THE TRUSTEES IN THEIR CONSIDERATION OF YOUR APPLICATION. THANK YOU.
1 / Overtype your name here / Aged ?? :
Date of Birth
DD-MM-YYYY / Date of App :
DD-MM-YYYY
2 / Overtype your address here – include postcode / Amount - £
How much do you need to help you?
CONTACT DETAILS LANDLINE
- MOBILE
Payment is made either direct to suppliers of goods or in some cases direct to you via online banking – to receive payment please provide your
BANK ACCOUNT NAME -
BANK SORT CODE -
BANK ACCOUNT NUMBER -
3 / OTHER FAMILY LIVING WITH YOU / AGE / RELATIONSHIP
Name of person living with you
2nd person
3rd person
etc / In years / Relationship to you
4 / Purpose : what do you need funding for ?
4a / Related Course : Enter relevant course detail you need support for
4b / EDUCATION
Secondary education
Sixth form
Any Further Education / ACHIEVEMENTS
List exams etc here with grades in (brackets)
List exams etc here with grades in (brackets)
List exams etc here with grades in (brackets)
5 / Previous Grant :
Have you applied to this fund previously?
If so provide details / Applied for other grants:
Have you applied to any other fund or Trust for assistance – if so provide details , especially the Council’s Discretionary Crisis Fund (DCF)
6 / EMPLOYMENT / List any job/s you hold
7 / INCOME from employment (take home) – list all who work in the household / £PER MONTH
YOURSELF
2nd person
3rd Person
etc
8 / OTHER INCOME OR BENEFITS / £ PERMONTH
- ESA or JSA or UC / £
- DLA / £
- Pensions / £
- Child Benefit / £
- Child Tax Credit / £
- Rent or Board/lodgings paid by those living with you / £
- other income or benefits– / £
- other income or benefits– / £
- other income or benefits– / £
If applying for educational Trust support add
-Student Loan provided (per month) / £
-Student finance grant (per month) / £
-Any Parental support (per month) / £
9 / TOTAL INCOME / Enter total of everything above - £
10 / TOTAL FAMILY EXPENDITURE / Enter total of everything below - £
- Rent/Mortgage / £
- Council Tax / £
- Water Rates / £
- Insurance / £
- Housekeeping / £
- Heating/Lighting/Cooking / £
- Telephone and TV /broadband services / £
- Travel to Work or travel costs / £
- CCJs / £
- Social Fund repayments / £
- Loan repayments / £
- other (specify) / £
- other (specify) / £
- other (specify) / £
ADDITIONAL SUPPORTING INFORMATION
Enter any additional supporting information here –please include details of course/training and full contact details for course tutor who can verify your details.
REF MET / DECISION :
GUIDANCE NOTES
APPLICATION FORMS SHOULD BE COMPLETED IN FULL TO AVOID ANY DELAY. TAKE CARE TO WORK OUT YOUR MONTHLY INCOME AND EXPENDITURE.
For further information either e-mail or write to the address on the form and you will be contacted shortly afterwards.
Who can apply for the Middleton Educational Trust?
You should be a resident of the Middleton area, or attend, or have attended, a school in Middleton.
How can the Trust help?
We can provide assistance for any purpose that promotes the education, training and development of the applicant, or helps ease financial barriers to achieve required education, training or development.
Restrictions: the Trustees do not provide funds
-to meet the full cost of fees or expenses, unless exceptional hardship is shown on the application.
Please note there is no age limit for applicants.
Trustees decision on any application is final and, once the applicant is informed, no further correspondence regarding that decision will be entered into.If additional relevant information regarding the original application becomes available, or personal circumstances change, the applicant may make a fresh application.