Bursary Application

Please read the GUIDANCE NOTES BEFORE completing this form, and have copies of all supporting documents available. This form needs to be signed by both parents/guardians where possible so that your application can be considered without delay. A home visit to support your application may be requested.
Child's Details
Your daughter's surname*
Your daughter's first name(s)*
Date of Birth*
DD slash MM slash YYYY
Year of Entry*
Applying for*
- Year 7
- Year 12

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Please refer to the guidance notes when completing this part of the application.
Parent/Guardian Details
Are you a single parent/guardian?*
- Yes
- No
First Signatory
Title*
Full Name*
Contact Tel No.*
Relationship to Child*
Email Address*
Postal Address*
Street Address Address Line 2 City Postcode
Employment Status*
- Employed
- Self Employed
- Unemployed
- Full-Time
- Part-Time
Employment Details
Occupation*
Work telephone No.*
Name & address of employer or business address including postcode*
Street Address Address Line 2 City Postcode
Second Signatory
Title*
Full Name*
Contact Tel No.*
Relationship to Child*
Email Address*
Postal Address*
Street Address Address Line 2 City Postcode
Employment Status*
- Employed
- Self Employed
- Unemployed
- Full-Time
- Part-Time
Employment Details
Occupation*
Work telephone No.*
Name & address of employer or business address including postcode*
Street Address Address Line 2 City Postcode
Hidden
Signatory Details
Title*
Full Name*
Contact Tel No.*
Relationship to Child*
Email Address*
Postal Address*
Street Address Address Line 2 City Postcode
Employment Status*
- Employed
- Self Employed
- Unemployed
- Full-Time
- Part-Time
Employment Details
Occupation*
Work telephone No.*
Name & address of employer or business address including postcode*
Street Address Address Line 2 City Postcode
Parental Responsibilities
Please indicate the reason this application is being completed by one parent only*
- Divorced
- Separated
- Widowed
- Absent
- Other
Please provide any relevant details*
Does the other parent/guardian have parental responsibility for this child?*
- Yes
- No
Please provide any relevant details*

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Please refer to the guidance notes when completing this part of the application.
Income (Per Annum)
Please complete the fields below showing income from ALL SOURCES, before deduction of any tax. If not applicable enter 0.
First Signatory
Gross Salary
2019/20 Actual £ Per annum*
2020/21 Estimate £ Per annum*
Payslip, P60, P11D*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Gross pensions received
2019/20 Actual £ Per annum
2020/21 Estimate £ Per annum
Supporting documentation
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Second Signatory
Gross Salary
2019/20 Actual £ Per annum*
2020/21 Estimate £ Per annum*
Payslip, P60, P11D*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Gross pensions received
2019/20 Actual £ Per annum
2020/21 Estimate £ Per annum
Supporting documentation
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Hidden
Signatory Details
Gross Salary
2019/20 Actual £ Per annum*
2020/21 Estimate £ Per annum*
Payslip, P60, P11D*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Gross pensions received
2018/19 Actual £ Per annum
2019/20 Estimate £ Per annum
Supporting documentation
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.

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Please read item number 5 in the guidance notes before completing this section.
Assets
Bank/Building Society
How many bank/building society accounts do you have?*
Bank/Building Society Name*
Balance £*
Statement (last 3 months)*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Bank/Building Society Name*
Balance £*
Statement (last 3 months)*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Bank/Building Society Name*
Balance £*
Statement (last 3 months)*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Bank/Building Society Name*
Balance £*
Statement (last 3 months)*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Other Investments (eg ISA, Bonds, Stocks & Shares)
How many other investments would you like to add?*
Type of Investment*
Balance £*
Statement*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Type of Investment*
Balance £*
Statement*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Type of Investment*
Balance £*
Statement*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Type of Investment*
Balance £*
Statement*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Properties
How many properties do you own?*
List all properties you own including where you live (if you own that property)
Address*
Mortgage outstanding on property*
Estimated value of property*
Address*
Mortgage outstanding on property*
Estimated value of property*
Address*
Mortgage outstanding on property*
Estimated value of property*
Address*
Mortgage outstanding on property*
Estimated value of property*

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Please refer to the guidance notes when completing this part of the application.
Outgoings
I/we have the following monthly outgoings
- Mortgage payments
- Rental payments
- Pension contributions
- Loan and Credit card payments
- Other large outgoings
Mortgage payments
Amount - monthly*
Mortgage statement for each property*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Rental payments
Amount - monthly*
Rent agreement/contract/letter*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Pension contributions
Amount - monthly*
Pension letter*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Loan and Credit card payments
Amount - monthly*
Loan/credit card statements*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.
Other large outgoings
Amount - monthly*
Letters/statements*
Accepted file types: doc, docx, pdf, jpg, jpeg, gif, png, Max. file size: 300 MB.

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Please refer to the guidance notes when completing this part of the application.
Dependent Children
Please give details of ALL dependents, including the child for whom this application is made. If applicable, add details of any current bursary award you are in receipt of from another school(s).
How many dependent children would you like to add?*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*

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Please refer to the guidance notes when completing this part of the application.
Other Dependents
If you qualify for a Carer’s Allowance, or have an aged grandparent or relative living with you or dependent upon you, please provide details including age, address, condition, etc.
How many other dependents do you have?*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*
Name of dependent*
Date of birth*
DD slash MM slash YYYY
Relation to dependent/Reason dependency*
Amount of any allowance received for this dependent (£ Annually)*

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Please refer to the guidance notes when completing this part of the application.
Any Other Relevant Information
Please use this space to add any other relevant information about your bursary application.

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Declaration
Following completion of this form, the following declaration should be signed by both parents/guardians where possible and applicable.

I / We declare that to the best of my/our knowledge and belief, all particulars submitted are true and contain a full statement of my/our income from ALL sources during the period shown.

I /We understand that the provision of false information may lead to my; our child being disqualified from assistance under the scheme.

I /We undertake to report immediately any material change in the financial position declared on this form.
First Signatory
Full Name*
Date*
DD slash MM slash YYYY
Signature*
Second Signatory
Full Name*
Date*
DD slash MM slash YYYY
Signature*
Hidden
Signatory
Full Name*
Date*
DD slash MM slash YYYY
Signature*
How We Use This Information
We will use the information included in this form to assess your family’s financial position and the level of bursary support you would need should we be able to offer your daughter a place at the school.

Bursary Application Forms, with supporting documents, are retained for the duration of time that a pupil is on the school role as a minimum. A new form is required to be completed on an annual basis.

If you are unsuccessful in obtaining financial assistance, we will retain your application for no longer than is necessary and not normally more than one year after receipt of your application.

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Bursary Application

Step 1 of 10

Child's Details

Parent/Guardian Details

First Signatory

Employment Details

Second Signatory

Employment Details

Signatory Details

Employment Details

Parental Responsibilities

Income (Per Annum)

First Signatory

Gross Salary

Gross pensions received

Second Signatory

Gross Salary

Gross pensions received

Signatory Details

Gross Salary

Gross pensions received

Other Income Details

Government Benefits

Child Benefit

Tax Credits

Income Support

Housing Benefit

Carer's Allowance

Other Benefits

Other Income

Income from properties

Income from investments

Maintenance payments/Allowances

Additional Income

Contributions

Assets

Bank/Building Society

Other Investments (eg ISA, Bonds, Stocks & Shares)

Properties

Outgoings

Mortgage payments

Rental payments

Pension contributions

Loan and Credit card payments

Other large outgoings

Dependent Children

Other Dependents

Any Other Relevant Information

Declaration

First Signatory

Second Signatory

Signatory

How We Use This Information