Registered charity 306229
Do you live independently of parents/guardians when in Dorchester and self-supporting?
To be completed by the applicant.
I am currently in Local Authority Care
I am currently living independently having left Local Authority Care
I am currently in receipt of Income Support/Universal Credit and financially supporting
myself and/or a dependent (ie child or partner)
I am in receipt of Disability Living Allowance or Personal Independence Payments and Employment
Support Allowance or Universal Credit in my own right
I currently live independently of any family or other support
Please upload copies of any written evidence of circumstances to support your
application at the end of this form.
To be completed by parent/guardian or applicant if self-supporting.
The applicant receives/received free school meals
The applicant receives/received the 16-19 bursary (or similar)
The applicant has caring responsibilities for anyone in the family
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.
Child Tax Credit
Working Tax Credit
Job Seekers' Allowance
Pension Guarantee Credit
Employment and Support Allowance
Support under Part IV of the Immigration and Asylum Act 1999
Most recent P60 or Salary Statement
This page was completed by:
Photos or screenshots are acceptable
Alternatively, you can send copies of supporting documentation to:
Mrs. Christine Bussell
Clerk to the Trustees
Ashley, Churchill & Thorner Educational Trust
4 Warne Hill
Bridport DT6 4AQ
Please send any queries to email@example.com or telephone 01308 423906 (please leave a message).
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.
Do not hesitate to contact us if you have any questions or queries.
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