Mary Trevelyan Hardship Fund

Mary Trevelyan Hardship Fund
Full name with Title *
Email*
example@example.com
Please state your University. *
*If your institution is not on the list, please do not proceed with this application.
Title of course and Qualification (eg BA, BSc, MA)*
Year of study*
Course start date*

DayMonthYear
Date
Course completion date*

DayMonthYear
Date
What is your Tuition Fee Status?*
What is your immigration status in the UK?*
Telephone number*
Please enter a valid phone number.
Address in London*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

DayMonthYear
Date
Place of Birth *
Nationality *
Marital status*
Have you applied to other charities or trusts for funding? (Give details)*
Please give details of how your funding arrangements have changed since you have commenced your course? What unforeseen circumstances have affected your finances?*
How much Funding are you seeking? (£)*

MONTHLY INCOME (all money coming in to your account)*

	£
Sponsorship (Scholarships or grants)
Parental contribution
Partner's/Spouse's contribution
Earnings from part-time work
Personal savings
Bank overdraft
Loans
Any other income
TOTAL INCOME

MONTHLY EXPENDITURE (all money coming out of your account)*

	£
Rent/Mortgage
Telephone and Internet
Gas/electricity/water
Food, toiletries, household goods etc
Tuition fees (state if already paid or pending)
Childcare
Transport (buses / trains) costs:
TOTAL EXPENDITURE

£

Total Income - Total Expenditure = Surplus/Deficit*
Supporting Documents

Please attach as many of the following documents as you can

you MUST submit the following documents*:

Confirmation of full-time enrolment from college/university
Confirmation of the amount of your fees and evidence of payment
Evidence of any unforeseen difficulties or expenses you have encountered
Your recent bank statement (at least the past 1 month - for all bank accounts you hold)

* Please note if you fail to submit these documents your application will not be passed to the committee for review

Please submit the following documents if applicable/to strengthen your application

Confirmation of any scholarship or grants you have been awarded
Evidence of other income, including savings and awards from other charities and trusts
Evidence of other expenses, including accommodation costs and outstanding debts
Reference from a college/university tutor or another person who is aware of your financial challenges
File Upload*

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Please note that in case your application is successful we would need you to complete a brief online follow-up survey examining the impact the funding has had. Please confirm your consent by ticking the following box*

I consent
Signature*

Clear
Date*

DayMonthYear
Date
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