THIS FORM IS FOR ARTS APPLICATIONS ONLY

Please do not USE abbreviations when making your application as panels will not be aware of what they are.

Section A

1.Name:

Gender: (Please tick)Male Female

2.Date of Birth:Telephone Number:

3.Address:

4.Present school/ College attending/Employment:

5.Which of the Arts activities are you involved with?

6.Are currently involved with an Arts group in Stevenage? If yes please name

7.Name of Examining Board:

8.What are your typical annual expenses associated with your Arts activity?

Travel: £

Equipment £

Including what type:

Tuition Fees: £

Examination Fees: £

9.How many lessons/activities do you attend per week?

10.How long is each session?

11.Briefly describe each session:

12.How regularly to do you perform? (If applicable)

13.What is your current level of achievement? E.g. Exam Grade taken, competitions entered, classes attended.

14.What do you consider to be your best achievement to date?

15.How would you like to build upon your achievements?

Section B – This must be completed by anyone who has received a grant in the last 2 years

16. Please list your achievements and progressionsince your last grant?

Section C

  1. Please write in no more than 200 words why you feel you should be given this award. (Must be written by young person)

ENDORSEMENT FOR ART: TEACHER / GROUP LEADER / OTHER

Name:Telephone number:

Address:

Email address :

Position:Qualification:

How long have you taught the applicant?

Do you support the application for the grant? (Please tick)Yes: No:

Can you confirm the details are accurate? (Please tick) Yes: No:

Do you agree that the plans / targets are realistic and achievable?

(Please tick)Yes: No:

Comments in support of the grant application:

I acknowledge that the information in this application is true and I have not withheld any information, which may be relevant to this application:

N.B. If we are unsure of any information we will contact the endorser for confirmation

Print name of Endorser:

Signature of Endorser:Date:

Signature of Applicant:Date:

Print Name of Parent / Guardian:

Signature of Parent / Guardian:Date:

THANK YOU FOR YOUR APPLICATION

Please make sure that all the required sections are completed correctly and you have completed the correct application form for your chosen talent, including a copy of your most recent exam report or equivalent.

Please return to:

Leisure Services

Stevenage Borough Council

Daneshill House

Danestrete

Stevenage

HertsSG1 1HN

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