MARGARET HARRISON TRAVEL BURSARY

APPLICATION FORM

Section 1 –Your personal details

Please, provide the following details about yourself:

Your surname:
Your first name(s):
Your address:
Your Country:
Home Tel. No: / Work Tel. No:
Mobile No: / E-mail:

Section 2 – Your organisation’s details

Please, provide details about your national/local Home-Start organisation:

National/local Home-Start organisation’s name and address:
Home-Start manager’s contact details:
Name:
Phone No:
Email:
Trustee of your Home-Start organisation acting as a referee:
Name:
Phone No:
Email:
Your role(s) at Home-Start (if more than one, please state start and end dates:

Section 3 – The hosting organisation

Please, provide the following details about the hosting organisation:

Name of the organisation:
Address:
Country:
Phone No: / E-mail:
Website:
Hosting organisation’s manager:
Name:
Phone No:
Email:
Brief description of the hosting organisation:
Who are you going to collaborate with in this organisation?
Name:
Role:
Phone No:
Email:

Section 4 – Purpose (objective) of the visit

Please provide the following details about your visit and why we should fund it:

Why would you like to visit this organisation? (max 400 words)
When would you like to go and for how long?
Describe the content of your visit (max 400 words)
Identify 4 outcomes that will be achieved throughthe visit that you will share with your scheme or at an event, one for each of the following categories:
  • Your personal development
  • Your own Home-Start
  • Your local community
  • More widely

We are looking for innovative and interactive projects for which communication will play a key role. How are you planningto share your learning with Home-Starts more widely?
And finally, draft 140 characters for use in social media to promote your projecte.g. Twitter.

Section 5 – Costs

Please provide full details of the cost of your visit and evidence in support of these costs (i.e.: screenshots of the flight tickets you would buy if you were shortlisted, etc.). Please note that if any check (i.e.: DBS) and Visas are required for your visit, this cost should be included in the ‘Other items of expenditure’ section.

For Worldwide Home-Starters, please provide costs in Sterling Pound (a Currency Converter is available at

Economy class travel expenses:
  • ______
  • ______
  • ______
  • ______
  • ______
/ £ ______
£ ______
£ ______
£ ______
£ ______
Accommodation:
  • ______
  • ______
  • ______
  • ______
  • ______
/ £ ______
£ ______
£ ______
£ ______
£ ______
Meals:
  • ______
  • ______
  • ______
  • ______
  • ______
/ £ ______
£ ______
£ ______
£ ______
£ ______
Other items of expenditure:
  • ______
  • ______
  • ______
  • ______
  • ______
/ £ ______
£ ______
£ ______
£ ______
£ ______
Total / £ ______

We understand that prices may change. Unfortunately, travel bursaries will have to be granted on the basis of what is stated in this application form and we will not be able to refund any other expenses which the successful applicant incurs.

Section 6 – References and Consent

Please,attach a reference lettersigned byone of your scheme’s Trustees and a confirmation letter signed by the hosting organisation’s manager.

Both Word and PDF versions are accepted.Wherever possible, letters should be on headed paper.

Reference lettersigned by your scheme’s manager (or by one of the Trustee if the scheme manager is applying). / Attached?
Yes No
Confirmation lettersigned by the hosting organisation’s manager / Attached?
Yes No

Awarded applicants must be willing to have photographs and names published by Home-Start UK and Home-Start Worldwide, along with a short write up of their travel experience and any other visual documents they might produce to promote the project.

During your visit to the hosting organisation, you are likely to want to take photos/videos to document your experience. Please, do not take photos/videos of children/vulnerable adults without the written consent of their parents/main carersor themselves if adults.Successful applicants will be provided with copies of a consent form and will be required to provide signed copies to Home-Start UK.

Section 7 - Declaration

I declare that, to the best of my knowledge and belief, all statements contained in this form are correct.I understand that, should I make a deliberate misrepresentation, any bursary offered to me may be claimed back by Home-Start UK.

I agree that, if successful, my report and any attached contents can be sharedwith my host organisation and with Home-Starts in the UK and in other countries.

Signed: Date:

______

Margaret Harrison Travel Bursary