PETITION FOR GRANT FROM THE DURHAM MASONIC EDUCATION OR SCHOLARSHIP FUNDS (please continue overleaf where necessary) Petitioner’s Name (Name of person making the application) (In full) Address Candidate’s Surname (The beneficiary of the petition) Christian Names Date of Birth Name of School Attending/Attended Examination Levels Obtained (GCSE/A-Level/Other) Intended Profession Details of Proposed Course of Study or Professional Examinations College/School where Course will be taken Fees Grant from Local Authority (or Other Organisation) Name of Candidate’s Father Name of Father’s Lodge and Lodge No. Financial Circumstances of Parents Income Pension Supplementary Allowance Interest Investments and other Assets Any other Income Reason for short term grant Any further information
Date
__________________________________________ 20
Signed ___________________________________________________(Benevolent Representative)
Lodge Name & No _______________________________________________________
April 2010