Benslow Music Instrument Loan Scheme Bursary Application
Please fill in the fields below to apply for a Benslow Music Instrument Loan Scheme bursary. If you need any help or want to do this in another way, please contact our small, friendly team on instrumentloan@benslowmusic.org or call 01462 429207.
We ask that this is completed in full by the parent / guardian supporting the student application. Our bursaries are usually awarded to households with a gross annual income of less than £60,000 but this is solely at the discretion of BMILS. You will be notified before your first monthly payment if you have been successful. Please send your documentary evidence within the four week trial period to annette.hoar@benslowmusic.org.
Guarantor name
Guarantors - please tell us about the student whose application you are supporting below
The student's full name
*
Date of birth
*
-
Month
-
Day
Year
Their full address including postcode
*
Please tell us about your circumstances
Are you a single parent household?
Yes
No
How many dependents under the age of 21 are in your household?
Do you have other children who are borrowing an instrument from us?
Yes
No
If you do have other children borrowing and instrument from us - please tell us their names
Is your child currently receiving support from your Local Authority or any other funding body or source?
Yes
No
Do you have any dependent relatives living with you?
Yes
No
If you do have dependent relatives living with you, please tell us about them below
Is there anything else you feel it would be useful for us to know about or any extenuating circumstances we should be aware of?
Please tell us about your annual household income
Please supply documentary evidence for each benefit received
Employment / Pension income of the household
*
Rows
Total £
Combined salary of all adults living in the household
Income from pensions (state or private)
Income from savings or investments
Income from child maintenance service
Income from absent partner/parent/other adult
Any other income not listed above
Total
Income from benefits
Rows
Total £
Child benefit
Universal credit
Personal Independence Payment (PIP)
Adult disability payment (Scotland only)
Employment and Support Allowance (ESA)
Carers allowance
Other benefit - please give details
Total
The information given in this application is correct to the best of my knowledge
Please sign below to agree
Your Signature
Date
-
Day
-
Month
Year
Your full name
First Name
Last Name
Your email
Your mobile number
How we handle your information
Data storage
*
I confirm that I give my permission for my data to be stored by BMILS for the purpose of managing my Instrument Loan Application and any subsequent instrument loan(s)
Submit
Submit
Registered Charity No. 313755 VAT registration no.829 9251 89. Benslow Music is the sole corporate trustee of the Benslow Musical Instrument Loan Scheme. Registered charity no.313663
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