The Eve Brook Scholarship Fund

Application Form

You may print this form and complete it manually. Or, you may complete this form online. Save it to the hard drive on your PC. Place the cursor in the shaded area and start typing. Use the TAB key to move from one field to the next.

Data Protection Act 1998

The information that is provided by you on this form is required for the purpose of assessing your eligibility and suitability for a grant from the Eve Brook Scholarship Fund. This information will be disclosed to the trustees and administrators of the Eve Brook Scholarship Fund only.

Your application for funding may be discussed with other organisations, such as Birmingham City Council, if it appears that Birmingham City Council is more likely to provide the funding than the Eve Brook Scholarship Fund.

Information provided by you will be checked for accuracy and stored securely. It will not be passed on without your written approval.

From time to time the Eve Brook Scholarship Fund may write to you to let you know of other services we can offer you.

If you do not wish us to keep in contact with you please mark this box

PLEASE READ THE ENCLOSED GUIDANCE SHEET AND COMPLETE ALL RELEVANT SECTIONS OF THE FORM.

If you wish, you may include any additional information on separate sheets and attach this to your application form.

YOU WILL NEED A SPONSOR TO PROVIDE A SUPPORTING LETTER FOR YOUR APPLICATION. Your sponsor could be your Aftercare Adviser/Social Worker/Foster career/ Teacher or any other responsible adult – SEE BELOW for ‘Sponsor’s Letter Guidance Notes’.

ABOUT YOUR SPONSOR
Name / Job title
Address
Postcode / Telephone

Please send your completed application to:

Sarah Barker, Team Manager 18+ Care Leavers Service, PO Box 16378, Birmingham, B2 2AH

For further information about the Eve Brook Scholarship Fund go to

1 ABOUT YOU
Forename / Date of birth
Family Name / Mobile Phone
Address
Postcode / Email
2 HOW CAN WE HELP YOU?
Which of the following would you like to apply for?
•SCHOLARSHIP (for support to pay course tuition fees) Yes/No
•BURSARY (for support for ongoing costs of travel, or childcare, or equipment/materials for your course, etc.) Yes/No
•FEES FOR A SHORT COURSE (such as a study week or similar) Yes/No
•ONE OFF GRANT (support for a particular need such as books or equipment Yes/No
•IT – we have reconditioned computers from time to time Yes/No
3 APPLICATION TO SUPPORT AN EXISTING COURSE OR A NEW ONE
a)Are you applying for help with a course you have already started? Yes/No
OR
b)Are you applying for help with a course you would like to start in the future? Yes/No
If (a) please complete Section 4 below
If (b) please complete Section 5 below
4 APPLYING FOR SUPPORT ON AN EXISTING COURSE
•Which school, college or other educational institution are you presently attending? Please provide the name and address.
•For what qualification are you studying? Please give course details, subjects and level of course.
•Please give the start and end dates of the course and if the course is full time or part time.
•What do you need the money for and how much are you requesting? Please give as much detail as possible on the costs of the things you are seeking and why you want help from the Eve Brook Scholarship Fund.
5 APPLYING FOR SUPPORT FOR A NEW COURSE
•Which college, University or other educational institution do you want to attend? Please provide the name and address.
•For what qualification are you studying? Please give course details, subjects and level of course.
•Please give the start and end dates of the course and if the course is full time or part time.
•What do you need the money for and how much are you requesting? Please give as much detail as possible on the costs of the things you are seeking and why you want help from the Eve Brook Scholarship Fund.
6. YOUR FINANCIAL CIRCUMSTANCES
What is your current source of income?
•Young person in care – income from Children’s services Yes/No
•Care Leaver – income from personal allowance Yes/No
•Care Leaver – income from benefits or earnings? Yes/No
•Other – please give details (e.g. student grant) Yes/No
Do you get any other help with study costs (such as from the Care Leavers Service or other source)? Please give details and ask your sponsor for help with this section if required.
Are you entitled to a student grant? Yes/No
Have you applied for a student grant? Yes/No
Is there anything else you would like us to know about your finances?
I hereby certify that the information I give above is accurate. I understand that if it is found to be misleading or incorrect, any monies awarded will be recovered in full.
Signature
Print Name / Date

PTO for Sponsor’s Letter Guidance Notes

SPONSOR’S LETTER GUIDANCE NOTES
Sponsors can be professionals (Social Workers, Aftercare Advisers, etc) or carers who can vouch for the young person and answer the following questions:
•Confirm dates in care, and date of leaving
•Confirm current source and amount of income
•Confirm entitlement to care leaver services
•Confirm eligibility and receipt of other funding sources such as: Care Leavers Grants & support, UK Student Grant /Loans, Other charitable funding, bursaries etc
•Tell us a bit more about the young person that is applying. How will the support of the Fund help/encourage them to achieve their educational ambitions?
MONITORING (sponsor to complete)
Name of Young Person
Ethnicity
Disability
Parenting responsibilities