Ullswater Community College Sixth Form Application Form for 16 -19 Bursary Form Name:
……………………………………………………
Address:
…………………………………………………… ……………………………………………………
Form: ………………………..
Postcode:
…………………
Year 12 and 13 students please tick the Level for which you are applying this year: Please tick appropriate box: Level 1 Level 2 Level 3 For Level 2 or 3 applications please describe below the specific educational purposes for which you are requesting funds: Item (e.g. educational equipment; enrichment tuition; educational trip, etc.)
Cost
Additional Sheets may be attached
N.B. Applications can be made for the cost of transport of the daily journey to and from school.
For all applications you have to provide evidence of your family’s financial hardship. Please explain circumstances below and attach photocopies of any one of the following documents: letter from Department of Work and Pensions setting out the benefit you are entitled to; P60; Tax Credit Award Notice; Income Support; Employment Support Allowance, Jobseeker’s Allowance, Disability Living Allowance; Free School Meals eligibility; other means-tested benefits.
Please return to: Mr Jackson, Ullswater Community College, Penrith. Office use only: Approved:
Refused:
Reason:
E:\Website\New New\Sixth Form\16-19_bursary_application_form.doc