Online Application

Email address*

Personal Details

Name*

Date of birth*

Address*

Postcode*

Telephone / Mobile*

Current Education / Training

School / College*

Course / Training title

Education / Training for which grant is sought

College / University / Provider*

Course / Training title*

Start date

Length of course

Course / Tuition fees

Are fees covered by a government loan or similar?

Yes No

If no, who will be paying the fees

What do you hope to achieve by obtaining this qualification?*

Are you applying for / receiving any other educational grant or scholarship?

If you consider it essential that part payment of this grant is given before you have enrolled, please give full details why you would like the trustees to consider this.

Please add any additional information relevant to this application.

Course / Training Costs: How do you intend to use a grant? Please provide as much detail as possible. You may attach any proof, such as a course equipment list.

Books

Essential Desirable

Special clothing

Essential Desirable

Tools

Essential Desirable

Other materials

Essential Desirable

Trips / visits

Essential Desirable

Other (please specify)

Essential Desirable

Supporting declaration We require confirmation that you are taking part in the course/training for which this grant is sought and that the expenditure required is reasonable. Please provide contact details of your tutor/mentor. If you are yet to enrol at the College/University/Provider for which this grant is sought, then please provide details (ie the admission dept) so that we can contact them once you have taken up your place.

Tutor / principal / mentor*

Department

Name of College / Provider*

Address*

Postcode*

Email*

I agree to ACTET contacting my college/university, provider, and seeking confirmation that I have enrolled on the course for which this grant is sought.

Digital signature

I declare that the information given in support of this application is correct and complete to the best of my knowledge and belief.

Enter your full name to agree*

Date*

Household / Personal Financial Circumstances (1 of 2)

Do you live independently of parents/guardians when in Dorchester and self-supporting?*

Yes No

Household / Personal Financial Circumstances (2 of 2)

To be completed by parent/guardian or applicant if self-supporting.

The applicant receives/received free school meals

Yes No

The applicant receives/received the 16-19 bursary (or similar)

Yes No

The applicant has caring responsibilities for anyone in the family

Yes No

Please provide details

How many dependent children are living in the same household?

If the applicant is financially self-supporting, please provide details

Please indicate which suggested evidence of financial circumstances you can provide and ensure that full copies of Tax Credit/Universal Credit awards, or other supporting documents are provided where possible. The more accurate picture of financial circumstances provided, the easier it will be for a decision to be reached on the award of grants.

Income Support

Yes No

Child Tax Credit

Yes No

Working Tax Credit

Yes No

Job Seekers' Allowance

Yes No

Universal Credit

Yes No

Pension Guarantee Credit

Yes No

Employment and Support Allowance

Yes No

Support under Part IV of the Immigration and Asylum Act 1999

Yes No

Most recent P60 or Salary Statement

Yes No

Other Evidence (please specify)

Please use this space to provide any further relevant information to support this application

This page was completed by:

Name*

Relationship to applicant (parent/guardian/self-supporting)*

Date*

We wish to promote our Charity more. Could you please tell us how you got our details?*

If an award is made, what is the name to be put on your cheque? (Note: you must have a bank account in this name).*

Supporting Documentation

Photos or screenshots are acceptable

Select files:

Alternatively, you can send copies of supporting documentation to:

Email: info@actet.org.uk

Address:
Dorchester Town Council
Ashley, Churchill & Thorner Educational Trust
19 North Square
Dorchester
DT1 1JF

Please send any queries to info@actet.org.uk.

Confirmation

To send your application to us, click on the Finish button below. Once you have done this you will no longer be able to return to the application, so before doing so, please ensure that everything you have entered (as summarised on the previous page) is correct.

Data Protection Statement

It is part of the Trustees responsibilities to ensure that applicants for grants are suitably qualified under the terms of the Charity’s Governing Instrument. Trustees therefore need to make appropriate investigations of each applicant. The personal data supplied on this form will be held on file and be used for the sole purpose of the Trustees of the Charity of ACTET to determine any award and will not be disclosed to any other individual or organisation.