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
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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.
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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
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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)
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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.
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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:
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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
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