Application Form for a JVenn Foundation Bursary: October 2017 Student Application Form Please type or complete in block capitals. Student’s Details: NAME: Date of Birth (dd/mm/yy) AB□□ Date of Birth must be after 31/08/94 WHICH SCHOOL/COLLEGE DO YOU OR DID YOU ATTEND? YOUR CONTACT DETAILS: HOME ADDRESS: POSTCODE EMAIL ADDRESS TELEPHONE/MOBILE NUMBER 1 WHICH ELIGIBILITY CONDITIONS DO YOU MEET? (You must tick one or more of the boxes – right click box, choose Properties, Checked, OK) Financial Disabled In care Carer Parent Minorities Applicants may give further information on their eligibility here or by attaching additional pages. Evidence must be supplied before short-listed candidates are interviewed. All information supplied to the Foundation will treated as strictly confidential. 2 Sponsor’s Details NAME OF SPONSOR RELATIONSHIP TO APPLICANT (For example: Form Teacher, College or School Principal) - The Sponsor should not be a family relative. SPONSOR’S EMAIL ADDRESS I confirm my sponsor has agreed to submit a statement regarding my application if I am selected for the short-list – please tick box or insert ‘X’ to confirm 3 PLEASE SAY WHAT OFFERS YOU HAVE BEEN GIVEN BY UNIVERSITIES WHICH UNIVERSITIES HAVE YOU CHOSEN FOR YOUR FIRST CHOICE AND FOR YOUR RESERVE AND WHICH SUBJECT HAVE YOU APPLIED FOR. First Choice Subject Conditional or unconditional Grades Required Reserve Subject Conditional or unconditional Grades Required WHAT A-LEVELS ARE YOU STUDYING / HAVE STUDIED? (Include grades) 4 SUBJECT GRADE IF AVAILABLE ADDITIONAL INFORMATION Support your application by including as much information as possible about your circumstances such as: work or volunteering experience, interests and sporting activities, achievements, challenges you’ve faced, your aspirations or hopes for the future.. This information will assist the trustees to make their decision. Please add extra sheets if you wish. This section must be completed. 5 Insert Text Here APPLICANT’S SIGNATURE…………………………………..…… DATE Applicants must complete and sign the attached bursary application form and submit it by 30th April 2017 to: 6 a) b) c) By email to [email protected] ; Directly to the Principal or Head of their college or school who will forward the applications to the Foundation; By post to: The JVenn Foundation, c/o HEY Smile Foundation The Loft, Dock Street, Hull HU1 3AE 7
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