The Roundhouse Is Committed to Ensuring All Young People Have Access to the Arts

Roundhouse Bursary

Application form

The Roundhouse is committed to ensuring all young people have access to the arts.

TheRoundhouse Bursary scheme is designed to support young people that may otherwise not be able to access Roundhouse resources on account of financial difficultly.

The Bursary can be used for a range of purposes such as;

Transport expenses to and from the Roundhouse (within the London area only)

Roundhouse project fees

Emerging Artist Membership Fees

Hiring rehearsal Space/ studio facilities at the Roundhouse

Materials related to a Roundhouse project

Accreditation costs

Childcare

Carer/Interpretator

Other items may be considered eligible for a bursary and will be assessed on a case by case basis. No cash will be given directly to a beneficiary of bursary. All applications are treated with the strictest of confidence.

On account of the high demand of bursary applicants and limited funds available the Roundhouse requests in the interest of honesty and fairness that you do not request a bursary unless there is a genuine need and inability to secure funds by other means.

Once we receive your application you will be contacted to make an appointment.Documentation may be sought as proof of need.

Please email your completed application forms to or post it to Bursary Scheme, Roundhouse, Chalk Farm Road, London NW1 8EH. If you need any help completing the form please call 0207 424 8477.

PERSONAL DETAILS

First name: / Surname:
Date of Birth (dd/mm/yy) Age / Gender
[ ] Male
[ ] Female
[ ] Would you describe your gender identity in another way?
Home Address / Contact Phone Numbers
Email
Address 2 ( if you have a different from above) / Contact Phone Numbers

Note: The information provided will be strictly confidential and only disclosed to senior members of staff related to the programme.

2. Reason for application (Please say why you feel eligible for a Roundhouse Bursary e.g unemployed etc)

3) What would you like to use the Bursary for?

4)What benefit do you think this bursary would bring to your future development?

5) Have you received a Roundhouse Bursary before? Yes/No

If Yes How much were you awarded?......

What did you use the bursary for?......

6. What level of formal education have you received?

…………………………………………………………………………

Are you currently engaged in education, employment or training? Yes/No

If Yes please specify…………………………………………………………………

Data Protection
The Roundhouse is a data controller for the purposes of the Date Protection Act (the “DPA”). A copy of the Roundhouse privacy policy can be found at www. Roundhouse.org.uk. As a data subject you have the right to request details of the information we hold about you and to delete or rectify any inaccurate information about you by sending us a written request stating your full name to:
The Data Controller
Roundhouse
Chalk Farm Road, London NW1 8EH
An administrative charge may be made for fulfilling this request.
As a data subject you have the right to ask us not to process your personal data for marketing purposes. We will inform you (before collecting your data) if we intend to use your data for such purposes or if we intend to disclose your information to any third party for such purposes. You can exercise your right to prevent such processing by checking certain boxes on the forms we use to collect your data. You can also exercise the right at any time by contacting us at or Data Controller, Roundhouse, 100A Chalk Farm Road, London NW1 8EH.
The Roundhouse will process the personal data and / or sensitive personal data in this application form (together with any additional personal data which the data subject may provide) in accordance with the DPA.
The personal data will be used for the purposes of processing beneficiaries of the bursary scheme as specified in this application form and other similar programmes which the Roundhouse considers might be suitable for them. The personal data will also be used for the purposes of monitoring the Roundhouse’s equal opportunities policies. By signing this form you consent to the processing of sensitive personal data (e.g. health information) by the Roundhouse for the purpose of this application. Should this application be unsuccessful, the Roundhouse will retain the personal data for one year.

Are you receiving any benefits? Yes/No

If Yes please specify………………………………………………………………

Do you have any dependants? Yes/No

If yes who and how many………………………………………………………………..

5. Please provide any further information that you feel will support your application

6. Please give the name and address of a referee:

Name Relationship to you:

Address:

Postcode:

Telephone:

How long has this person known you?

Candidate Declaration:
I certify that the information given on this form is, to the best of my knowledge, true and complete. I consent to members of the Roundhouse using the personal data and / or sensitive personal data in this application form (together with any additional personal data which I may provide to the Roundhouse) for the purposes set out above in accordance with the DPA and the Human Rights Act 1998.
Signed...... Date ......
NB Any false statement may be sufficient cause for rejection.