the rushworth trust

Form of Application for Financial Assistance for an Individual

Your full name If you are under 18 years old, please ask your parent or guardian to complete this form on your behalf
If the application is made on behalf of someone under 18, please state parent’s or guardian’s full name.
Your home address please include postcodes / Term-time address if different
Telephone: / Email: / D.O.B:
Details of your musical training, any relevant exams you have passed and any qualifications you hold. If there is not enough space provided on this form to answer any question adequately, please continue on another sheet of paper
If you are a student, please give details of the present stage of your education.
If you are not a student, Please give details of your occupation, employment or activities.
If you are a student, do you intend
(a) to adopt music as a profession?YESNO
(b) to reside in the Merseyside area?YESNO
What would the grant be used for?
What is the amount of the assistance you are seeking from the Trust? It is important that you state a figure, even if approximate. You should bear in mind that Funds available to the Trust are modest and that grants do not normally exceed £500.

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Why do you need financial assistance from the Rushworth Trust?
What is the full cost of the project?
£
What is the smallest amount of assistance from the Trust that would allow your project to go ahead?
£
If the full cost of the project exceeds the grant you are seeking, how do you intend to raise the difference? In answering this question, please include details and amounts of any assistance you have already obtained or been promised from other sources – family, scholarships, Local Authority grants, Local Arts funding etc.
Please list any Trusts, Funds etc to which you have applied without success (or from which you have had no reply yet). If you have not applied elsewhere for assistance, please say why not
If you are applying for funds to purchase an instrument, please provide documentary evidence of the full cost. Include an estimate from a supplier, for example
What is your present approximate annual income?
£
Documentary evidence must be supplied: copies of Tax Form P60 for the last financial year or similar official statements. If the application is made on behalf of someone under 18, details of the parents’ or guardians’ income should be given instead.
If the application is made on behalf of someone under 18, please state the number and ages of other dependent children
On a separate sheet, please give details of your current musical activities
Please say how you heard about the Rushworth Trust
If you are awarded a grant, to whom should the cheque be made out?

SignedDate

Please include with your application:
  • One or two letters of support from persons holding positions of responsibility who are familiar with your musical work
  • Any relevant quotations or estimates as noted above
  • Documentary evidence of income
NB Your application will not be considered without these documents

Please return this form to Community Investment and Grants, Liverpool CVS, 151 Dale Street, LiverpoolL2 2AH

the rushworth trust

CONFIRMATION OF DOCUMENTS ENCLOSED BY INDIVIDUAL

Each applicant MUST complete the following boxes:

I confirm that I have enclosed:(Please tick all boxes)

Documentary evidence of income*

(e.g. P60, wage slips or letter from Job Centre)

Estimate or quote from supplier

Letter(s) of support (re your musical work)

*If you are supported financially by another person (e.g. parent)

please provide evidence of their income

PLEASE NOTE:Your application cannot be considered without
ALL these documents.

Signed by: ______Dated: ______

The Rushworth Trust

Equal Opportunities Monitoring

Please complete the following brief questionnaire and submit it with your application for funding from the Rushworth Trust.
Please note that neither the manner in which you respond to this request for information nor the answers you provide will have any bearing on the way in which your application for funding is considered. If you choose not to provide any information, please tick the box provided.
The questionnaire does not identify you by name and the information you provide will be dealt with independently of your application for funding. Information obtained from this monitoring exercise will be made available to the trustees of the Rushworth Trust only in statistical format.
1. GenderPlease indicate your gender.
FEMALE

MALE

2. Ethnic OriginPlease indicate your ethnic grouping from the list below (by ethnic grouping we mean people who share the same cultural background and identity, not country of birth or nationality). Please tick one box.

AFRICAN

/

INDIAN

AFRO-CARIBBEAN

/

PAKISTANI

BANGLADESHI

/

WHITE BRITISH

BLACK BRITISH

/

OTHER (please specify below)

CHINESE

3. DisabilityPlease tick one box.

REGISTERED DISABLED

DISABLED BUT NOT REGISTERED

NOT DISABLED

If you choose not to provide this information, please tick here:

Thank you for your assistance.