Application for a Personal Award
CONFIDENTIALRef. No
HOCKERILL EDUCATIONAL FOUNDATION
APPLICATION FOR A PERSONAL AWARD
Please read through this form carefully before completing it in BLACK type or BLACK ink or ballpoint.
Return it by 31 March 2017 to the Secretary, 3 The Swallows, Harlow, Essex, CM17 0AR
Tel: 01279 420855 E-mail:
(Please ensure that all sections of the Application Form are completed in full and that dates are specified where requested)
About yourself
1. Surname (BLOCK LETTERS) ...... ………………..Title: Dr/Mr/Mrs/Miss/Ms or…….….
2. Fore names ...... ………………………………………………..
3. Address ...... ………………...... …………………...
...... Post Code .……………...…………...
4. Telephone No. …...... 5. E-mail: …...... ……….………………………………………..….
6. Date of Birth ………..…/……………./.…………. 7. Place of Birth …...... …………………...... …
8. Nationality ...... ………………………. 9. Are you classed as Overseas Student? YES / NO
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About the course of study/research for which you are requesting financial support:
10. Course title and final qualification…………………………………………………………………...………….…
11. University/College………………………………………………..……. 12. Full or part-time?…………….…...
13. Starting (month & year)……………………..…… and ending (month & year) ……………………………….
This is your opportunity to make a personal statement about you and your need for a Grant. In, between 100 and 250 words, please use the following questions to guide the development of your statement
14. How do you expect to make use of this qualification in your future career / employment?
15. How do you meet the Hockerill Foundation’s criteria for a Grant?
If you feel it would be helpful to give more details in reply to any question,
please use the back of the page to do so.
About your present position (school, university, work, unemployed, etc):
16School, college, employer, etc / From / To / Course, job, etc / Qualifications to be attempted
(if any)
17. If employed, what contribution (if any) will your present
employer make towards the cost of your course?
About your previous education
From / To / Subject(s) / Qualifications and levels obtained18. School (only if recent):
19. College / University:
20. Other relevant qualifications or achievements:
21. Name and address of your Local Education Authority:
About your previous experience of work (if any)
22. Most recent posts held and experience acquired:Employer(s) / From / To / Job title / description of work / Full/part-time?
If you feel it would be helpful to give more details in reply to any question,
please use the back of the page to do so.
About your financial resources and needs
The trustees ask about family or other special circumstancesonly to understand any additional financial commitments and needs you may have, and whether financial help may be available to you from a spouse, partner or parents where appropriate.
23. Family circumstances and any other special circumstances. Please include the number and ages of any dependants:24.Expected income in the coming academic year. If you do not know yet whether you will receive
some or all of the funding below, it is best to underestimate what you might receive, and let us know
if and when you are awarded any additional funds.
Student loan for fees / £
Student loan for maintenance / £
Any non-repayablegrant or bursary / £
Allowance for Disability, Children or Dependants (if any) / £
Contribution you hope to make each year from your own earnings/savings / £
Annual contribution (if any) from parents or partner / £
Any grants from other charities you have applied to.
Please state source, amount applied for, the result of your application or
when you expect to hear from them. / £
Any other bursaries or training salary not included so far / £
Estimated total income per year for the coming academic year / £
25. Estimated expenditure in the coming academic year. It helps us to know about
your needs but you will not be disadvantaged if you cannot give exact figures.
Course fees / £
Books, equipment, dissertation costs / £
Maintenance:
Accommodation (rent, mortgage, council tax, light, heat, water etc) / £
Personal living expenses (food, clothing etc) / £
Travel costs necessary for the course / £
Mortgage, credit or loan repayments / £
Other (please specify) / £
Student loan repayments, if any / £
Estimated total expenditure per yearin the coming year / £
After the year above, how many more years will your course last?
26. Contribution requested from The Hockerill Foundation in respect of:
Fees (if any) / £
Books, equipment, etc (if any) / £
Maintenance (if any) / £
Other (if any, please state) / £
Total requested / £
27. How did you hear about the Hockerill Educational Foundation? (Please give name of directory, internet site or advisory service if possible, in order that we can ensure their information is up-to-date).
28.Referees: Please give below the names and contact details of two people whom you have contacted and who are willing to provide a reference for you:
(i) Personal Referee (not a relative, but someone perhaps from a church or other organization who
knows you well and can confirm your personal qualities andcircumstances)
Name ………………………………...……………………………………...…...……...... …
Address ...... ………………………………...... ……...... …......
...... ………...... Post Code………………......
Tel. No...... …………… Email address (where possible)…………………………………………..
Referee’s position and how you are known to them………...... ……...... ….
(ii)Professional Referee (preferably a recentteacher, lecturer or employer, who is able to comment on
your present work and potential for the proposed course of study or research)
Name ...... …………………………….……………………………….
Address ...... …………………………………...
...... Post Code……………………....……
Tel. No...... …... Email address (where possible)……………..…………………………..
Referee’s professional position ………………...... ……...... ….
Please be aware that we will not necessarily take up references for every applicant.
29. Applicant’s statement:
I confirm that to the best of my knowledge and belief all the above information is correct and complete.
Your Signature ....…...... ……...………. Date ...... ……….……….
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This completed application form should be returned as soon as possible, and by 31 March 2017 at the latest, to: The Secretary, Hockerill Educational Foundation, 3 The Swallows, Harlow, Essex, CM17 0AR. Please enclose a self-addressed stamped envelope for the Trustees to inform you of their decision.
Notes:
All applications which fall within the Foundation’s objectives will be considered carefully after references have been obtained. If your application does not meet the criteria, you will be informed as soon as possible. The Trustees normally meet in May and June to agree Awards. Decisions are made according to established priorities and the needs of each individual case. Regrettably the funds available are usually insufficient to meet all applications which meet the criteria, and you should not rely on an award being granted. You should hear the result of your application by early July, but no information about an award can be expected before then.
Please remember that any award made by the Foundation is likely to be only a contribution towards your costs. The award will normally be for one year, but may be renewable for further years subject to satisfactory progress and an additional application. You should let the Secretary know immediately of any change in your circumstances, such as the receipt of a grant from another source or your withdrawal from a proposed course, which may affect the Trustees’ decision. Before you receive any award, you will be asked to sign an undertaking agreeing to certain conditions on which it is made.
Basic information about individuals is held on computer for the Foundation's record and membership purposes only, and is never made available to other bodies for commercial purposes, but it may be shared with similar grant-making Trustssuchas members of the Association of Church College Trusts (ACCT) in the interests of effective grant-making.
Individual 2017
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