CRICHTON FOUNDATION
APPLICATION FOR STUDENT FUNDING
You must complete all sections and use the checklist to ensure all of the information requested is
submitted. Please note that all correspondence will be sent to your student email address.
First name
Surname
Student ID Number
Home address
Student Email
Term address (if different)
Telephone
Mobile
Date of Birth
Marital/Civil Status
No. of dependants
Age(s) of children
Institution
Course
School
attended
College
attended
Year of study
Existing
qualifications
CHECKLIST
Supporting documents enclosed (copies please as original documents will not be returned)
SAAS Award letter (both sides)
Latest bank statements please highlight the following:





Wages/Salary
Tax Credits Award
Benefits (including Child Benefit)
Rent/Mortgage payments
Debt repayments, loan repayments, credit card payments
Academic transcript or printout of most recent grades achieved
Reference from course tutor or adviser of studies
Office use only
Academic
Excellence
Carson Reaching
Potential
Crichton Vision
Award
General
Application
Previous awards
Page 1
Page 3
Amount awarded
Cheque number
ID checked
Date issued
I confirm I have received payment of the above award from the Crichton Foundation
Signed
June 2015
Date
1
Supporting Statement
Please use this space to provide further information on your circumstances and explain how this support will
help you with your studies, for example details of additional course costs for field trips or similar.
June 2015
2
Income and expenditure
Self
Partner
SAAS funding
Student Loan
Employment income
Monthly expenditure
(include partner’s expenditure where applicable)
Housing
Costs
Monthly Income
Mortgage/Rent
Council Tax
Buildings/Contents Insurance
Utility Bills
Employment & Support
Allowance
Television Licence
Housing/Council Tax Benefit
Home Tel./TV/Broadband
Child Benefit
Bills
Job Seeker’s Allowance
Tax credits
Grant/Bursary/Scholarship/Trust
income (detailed below)
Other income (detailed below)
Travel
costs
Parental contribution
Mobile tel. (no. of mobile phones
in household ____)
Groceries (food, housekeeping,
toiletries etc.)
Debt repayments (detailed
below)
Car Insurance and Road Tax
(no. of cars in household ____)
Car fuel costs
Public Transport Costs
Course costs
(books, stationery etc.)
Others
Tuition fees
Child Care
Clothing/Shoes
Applicant’s total income
Entertainment
Partner’s total income
Other expenditure
(detailed below)
Total Monthly Household Income
Total Monthly Expenditure
Total monthly income minus total expenditure equals monthly excess/shortfall
Total savings and investments
Additional Income and Expenditure Information
Please use this space to provide additional information on income and expenditure to support your application,
details of outstanding debts and information on how you intend to fund your studies
June 2015
3
CRICHTON FOUNDATION
APPLICATION FOR STUDENT FUNDING
This Application Form should be used by individual students applying to the Crichton Foundation.
Information about the awards and grants available can be found on the Foundation web site
(www.crichtonfoundation.org). If you would like to discuss your application please contact us to
arrange a convenient appointment.
It is your responsibility to ensure all supporting information is received at the Foundation office prior to
the deadline for consideration at the next Awards and Grants Committee meeting, details of which are
available on our web site. All correspondence from the Foundation relating to your application will be
through your student email (home, work or private email addresses will not be accepted).
All information you supply with your application will be treated in the strictest confidence and stored
securely. Crichton Foundation staff, members of the Awards and Grants Committee and Student
Services staff are the only people who will have access to your application. Limited details of your
application may be discussed with your course tutor or adviser of studies if this is necessary to
support your application. Your personal information will not be disclosed to any third party.
Successful applicants will be required to submit a very brief report to the Awards and Grants
Committee stating how the funding has helped with their studies.
By submitting this application you are confirming that information provided is accurate and complete.
Please return your completed form by email to:
[email protected]
If you are unable to submit you application electronically you may submit your application to:
Awards and Grants Committee
Crichton Foundation
Browne House
Bankend Road
Dumfries
DG1 4ZZ
If you have any questions about your application please contact us by email or telephone:
Tel: 01387 702047 or 702048
Please keep this page for your records.
June 2015
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