FINANCIAL SUPPORT FOR PARTICIPANTS

Application Form

We aim to make sure our projects are open to as many people as possible and we want to ensure participants are not disadvantaged because of their financial situation.

For all projects we offer a limited number of FULL BURSARIES (free places) and ASSISTED PLACES (40% reduced places).

The financial support we offer is a limited resource, and demand for such places is extremely high. Applications are assessed against a set of criteria, with individual circumstances carefully considered by our team.

If you feel that you or your child / person you care for requires an Assisted Place or Full Bursary to take part in the project please complete the form below and return with relevant evidence of your situation. Please send photocopies or scans of evidence only as we are unable to return documents to you.

We aim to notify you of the outcome of this application within two weeks of receipt of the form. We may need to use data from your application to support with future funding bids.

To support our aim to help as many participants as possible we ask you notify us immediately if you circumstances change and you are no longer eligible for financial assistance- this is a condition of any financial support offered. We will review who we offer financial support on an annual basis and may ask for updated information and any place is subject to funding.

If you require further help in completing this form or need to discuss our Financial Support then please contact Jenny Jones on 01924 330065 or email:

Please return this application form and any supporting evidence via email, via post or in person to our box office to:

Jenny Jones

Theatre Royal Wakefield

Drury Lane

Wakefield

WF1 2TE

FINANCIAL SUPPORT FOR PARTICIPANTS

Application Form

What project are you applying for financial support with? (if this is an application for the Performance Academy please state WAKEFIELD or PONTEFRACT )

Details of Participant (the person who will be taking part in the project):

Name:

Address:

Date of Birth: Age:

Contact Number:

Email Address:

Details of the Parent / Guardian (if the participant is under 18):

Name:

Address (if different to above):

Contact Number:

Email Address:

(Continue overleaf)

Please tell us why you are applying for a financial support:

Please mark X to signify which circumstance applies to theparticipant, or provide thorough information if none of the stated criteria apply:

I am currently in care

I am under 18 and my parent(s)/ guardian(s) receive income support

I am under 18 and my family is in receipt of Tax Credit Awards

I am under 18 and my household income is £23,000 or less per annum

I am under 18 and my parent(s)/ guardian(s) receive Disability Living Allowance or a CarersAllowance, Job Seekers Allowance or Employment Support Allowance

OR

I am over 18 and I receive income support:

I am over 18 and my household income is £23,000 or less per annum

I am over 18 and I receive Disability Living Allowance, Carers Allowance, Job Seekers Allowance or Employment Support Allowance

OR

I have another reason other than those above to apply for financial support.

Please provide details:

If you are not awarded financial support will you still take part in the project?

YESNO

I have provided relevant evidence to accompany this application (photocopies only please).

If you are providing evidence of household income please tick one:

I am the sole earner in the household

There is more than one earner in the household and I include evidence of all earners incomes

Name of person completing form:

Signature:

Date: