Student Support Fund Application Form

Student Support Fund Application Form

This form is used to assess eligibility for discretionary financial support from the Trust's Student Support Fund.
Connie Rothman Learning Trust does not use formal income means testing. Instead, support is awarded where a financial contribution would cause financial hardship or create a barrier to accessing education.
Parent/Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Name of Student*

First NameLast Name
Student Year Group*
Eligibility Confirmation*

The request relates to a cost or contribution connected to the student's educationWithout support, this cost would present a barrier to participation, attendance, or access to education
What are you applying for support with:
Indicators of Financial Hardship or Need

Please tick all statements that apply. Supporting evidence may be requested where available but full income details are not required.
Financial circumstances

The student is currently eligible for Free School Meals or has been recently eligibleThe household receives government benefits (e.g. Universal Credit, Tax Credits)Meeting the cost would cause financial difficulty for the householdThere has been a recent change in financial circumstances (e.g. job loss, illness, bereavement)
Personal or family circumstances

The student has caring responsibilities that affect their ability to engage fully in educationThere are medical, SEND, or wellbeing-related needs that increase financial pressure or barriersThere are other exceptional circumstances affecting access to education
If you have ticked the final option above, please briefly explain below:
If you would like to provide further information about your circumstances that you do not feel was covered in the above questions, please do so below.
Declaration*

I confirm that the information provided is accurate to the best of my knowledge. I understand that support is discretionary and subject to available funds.
Signature*

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Student Support Fund Application Form

Indicators of Financial Hardship or Need