GRANT APPLICATION

(Please write only in the white boxes)

Personal details
Surname:
First names:
Title: / MrMissMrsOther (Please specify) / Gender: / FemaleMale
Address:
Postcode:
How long have you lived at this address?
If less than 1 years, please give previous address below:
Postcode:
Daytime Tel. No: / Evening Tel. No.
E-mail address:
Date of Birth: / Age (in years only):
Nationality: / Status, if not British
Any disability? / YesNo / If yes, nature of disability
Do you have any dependants? / YesNo / If yes, please give details below:
Name: / Relationship: / Please describe the nature of your obligation:

* Please attach proof of your nationality/residency status

Your course
College/training provider
Address of college/training provider:
Postcode:
Title of course: / Level of study:
Start date: / Finish date:
Type of study – Full time? / YesNo / Part time? / YesNo / Distance learning? / YesNo
No of weeks attending college: / Your highest qualification to date:

* Please attach/enclose any relevant information about your course

Details of the grant you are requesting (all amounts in £ please)
Fees £: / Course costs £:
Travel – From: / To: / Distance (miles):
Travel cost per week £: / Childcare costs per week £:
Total travel cost £: / Total childcare cost £:
Overall grant request £:

* Fees include tuition, registration, enrolment, examination fees and such costs

* Course costs include required books, equipment, etc.

* For childcare costs, please attach name of provider and their Ofsted Registration number

* Grant awarded will be paid directly to the college/training provider. Please include their details:

College/training provider’s payment details
Financing your course
Have you made any other grant applications? / YesNo / If yes, please give details below and the amount awarded(in maximum 100 words):
If you need more funds than the maximum grant we can make, please tell us how you plan to raise the rest of the money(in maximum 100 words please):
Personal statement
Please tell us briefly about yourself, what job you are aiming to do in the future, how this course will help you achieve that ambition and anything you have done so far towards it (maximum 250 words please):
Reference (To be completed by your college, teacher or your training provider)
Name / Position
I am able to support this application for a grant because:

* If more convenient, a letter of reference on headed notepaper may be attached to the application.

Confidential statement of financial circumstances *
Father/
Step father (£) / Mother/
Step mother (£) / Total
(£)
Occupation
Total income
(please enclose any relevant evidence)
Rent/Mortgage costs
All other outgoings
Approximate value of investments
Approximate value of owned residence
Approximate value of all other owned assets e.g. cars, jewellery, painting, etc
Approximate value of businesses owned (or share of business owned)
Outstanding liabilities e.g. mortgages, car loans, etc
Number of other dependent children (in No)
Approximate total education costs of other dependent children
Declaration
Yes/No
I declare that the information on this form is correct to the best of my knowledge and belief. I understand that the information I have providedwill be held and processed in accordance with the Data Protection Act 1998 and will be used by Tobi Adeyemi Foundation and its agents to carry out grant processing, analysis, auditing, accounting and other necessary duties. This includes transfer to and use by such individuals and organisations as the Foundation deems appropriate. The information on this form may also be used as a case study on our website and in publicity and reports, with personal details changed to ensure anonymity. / YesNo
I also declare that personal information that I have supplied about any other individual is supplied with that individual’s consent and is also subject to the declaration above. / YesNo

Completed Application Forms, together with any other relevant information should be:

  • e-mailed to , or
  • posted to The Executive Secretary, Tobi Adeyemi Foundation, 3 Vicarage Close, Kingswood, Surrey KT20 6QF