16-19 Bursary Application Form

Please read and complete this form carefully, filling in all relevant sections. All mandatory sections are marked with a * and must be filled in to submit this form.

Section A: Student Details

Student's First Name* Student's Second Name* Student's Full Address* Tutor Group* Please select the category of bursary that you are applying for*

Section B: Parent/Carer Details

Please provide details of adult(s) contributing to household income.

Only complete if applying for a Category D Bursary. Please complete for every adult in residence at the student’s main address, providing evidence as required.

Parent/Carer 1: First Name Parent/Carer 1: Second Name Parent/Carer 1: Full Address Parent/Carer 1: Evidence of Income (please select the form of evidence you are providing) Parent/Carer 1: Evidence of Income (please upload here) No file chosen Parent/Carer 1: Relationship to Student Parent/Carer 2: First Name Parent/Carer 2: Second Name Parent/Carer 2: Full Address Parent/Carer 2: Relationship to Student Parent/Carer 1: Evidence of Income (please select the form of evidence you are providing) Parent/Carer 1: Evidence of Income (please upload here) No file chosen

Important Information

For the purpose of this application, ‘household income’ is defined as the combined income (before deductions) of adults living at the student’s main address (as given above).

When submitting this application, you must provide evidence to support your claim to have a household income of £25,521 or less for the tax year ended 5^th April 2023. Photocopies of this documentation will be Retained for our records.

Section C: Details of Financial Support Requested

Please provide details below for the financial support requested, giving a brief description of each request.

Transport to enable school attendance Specialist books and equipment University open days and interviews Educational Trips relevant to study Meals Requests not covered above

Section D: Student Bank Details

Any bursary payable must be made directly into the student’s bank account.

Name on Bank Account* Bank Account Number* Bank Account Sort Code*

Section E: Student Declaration

I understand that in order to receive my bursary payments:

I must not have any serious attendance concerns
I must not break the terms of my Sixth Form Home School Contract
I must maintain a positive focus on my studies and meet work deadlines.

Failure to comply with the above points or any actions deemed to be unsuitable for students may result in a withdrawal of remaining funds. This decision is at the discretion of the Head of Sixth Form.

You have the right to appeal and/or complain if you feel your claim has not been given fair consideration. Appeals should be made to Mr Bowden, Deputy Headteacher.

I understand that if I do not comply with these terms, then I will not receive the 16-19 Bursary Fund payment for the period in question.

Student's Full Name*

By ticking this box your are digitally signing this declaration*I confirm that I have read and agree to the above information

Section F: Parent/Carer Declaration

I confirm that the details I have given in the application form are true and accurate.

I understand that should the student leave the school they will not be eligible to receive further payments and overpayments may have to be repaid.

I take full responsibility for informing the school immediately should my/our financial status change.

I understand that funding covers only this academic year and that we must reapply next year (there is no guarantee of funding for future years).

Parent/Carer's Full Name*

By ticking this box your are digitally signing this declaration*I confirm that the information that I have given is correct. I have included appropriate evidence of household income (if applying for a Category D Bursary).

Fulston Manor School A Fulston Manor Academies Trust School