BURSARY APPLICATION FORM

BURSARY APPLICATION FORM

We offer a small number of bursaries to support circus skill class attendance (applied for a term at a time), circus camps, workshops and performance and competitions expenses for ages 4-18years. These bursaries offer free or subsidised places to children from low income households. Everyone is welcome to apply, however priority will be given to local, low income residents. You will be notified if you are successful and the percentage we are able to offer shortly after the cut off date for each term. However please be aware we have very limited funds and are only able to help a few applicants each year.
Your Details
Childs Name*

First NameLast Name
Birth Date of child*

MonthDayYear
Address of child*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of person completing this form.*

First NameLast Name
Relationship to child*
Email*
example@example.com
Phone Number*

Area CodePhone Number

Activity Information

Please provide as much information as possible about the activities you are applying to be funded.
Activity Name*
Activity Start Date*

MonthDayYear
Date
What organisation is delivering the activity?*
Location of activity*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide full details of the activity you require help funding. *
Please include cost, duration, activity type and anything else that may be relevant

About Your Financial Circumstances

In this section we will ask you about your current financial circumstances. Please be as accurate as possible.
PLEASE NOTE

We are aware that multiple factors contribute to a familys circumstances so we do take more than just household income into account. However we do need to ask specific questions to be able to accurately understand your circumstances.

Not all questions may seem relevant but some questions are specific to certain available funding objectives.

Household Income

Please provide your household income as either a annual or monthly figure. Your application will not be considered without these details.

This figure should include:
- Salaried income
- Benefits and allowences
- Child maintenances or other payments from another household
- Any other income
If the young person is a member of more than one househoild, please give a joint figure for all households.

Please provide your household income*

	Household Income (£)
Monthly
Annual

Do you receive any of the following (tick all that apply)

Housing benefit (or universal credit equivalent)Income support (or universal credit equivalent)Jobseekers Allowance (or universal credit equivalent)Disability AllowanceCarers' AllowanceOther
Does the young person qualify for free school meals?*

YesNoPrefer not to say
Please give details of any financial obligations which affect your income. (e.g. other dependants, significant expenses outside the general cost of living, recent changes to employment etc..)
Please list any extra-curricular activities the young person currently takes part in.
Is there anything else you would like us to take into consideration when reviewing your application?

Funding Levels
Please let us know if a partial bursary is an option for you?*

I can manage 50% of the activity costI can manage 25% of the activity costI would require a bursary for the full cost of the activity.
If your application is successful, your child would need to attend at least 80% of all financed sessions. Please confirm you agree to this term.*

I confirm my child will attend at least 80% of all sessions
I confirm that to the best of my knowledge, the information provided in this form is accurate and honest
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