Bursary Application Form 2021

Please read the Bursary Scheme Guidance Notes 2021-22 carefully before filling in this form

Forms must be received no later than 5pm on Friday 10 December 2021.

Bursary Application Form 2021/22

Section A - Personal Details
Name*
Miss/Mr/Ms First Last
Address*
Please provide contact details where so we can contact you about this application.
Street Address Address Line 2 Town or City County Postcode
Phone*
Email*

This will be used to contact you about your application so please check it carefully
Mode of study eg full time/part time/block release
Name of UK College, University or Institution
Title of course/qualification
Which year group will you be in for 2021/22? (eg 1st year, 2nd year, final year)
Start date of course
MM slash DD slash YYYY
Name and job title of personal tutor/course director/supervisor who we can contact about your application.
Please give their contact details (email address and/or phone number)
How did you hear about the bursary scheme?
Have you applied for a Spectacle Makers' bursary before?
Please state your highest level of academic achievement so far, with subject(s) and grades eg A levels - Chemistry (B), Biology (C), BTEC Level 3 Health and Social Care (Merit)
Names and addresses of schools/colleges attended since the age of 11
Voluntary Work/Work Experience: list here any voluntary roles or work experience placements lasting more than 2 weeks*
Employment History: please give the job title, dates and brief details of any paid employment
Current Salary
Number and age of any dependents
Section B - Application Details
Why did you choose this course and profession? (Max 200 words)
If you had not been offered a place on this course, what would you have done instead? (Max 100 words)
What is the hardest thing you’ve ever done? (max 50 words)
What is the best thing you’ve ever done? (max 50 words)
Do you qualify for a Student Loan? If not, please explain how your course is being funded. (Max 50 words)
Please list any other grants you have applied for, and any other grants you have received in respect of this course
Why do you need a £1000 bursary? (Max 200 words)
Credit will be given for clear explanations and costs/outline budgets.
Please tick the box to confirm the above information and make the following statement:*

I confirm that I have completed this form without any assistance. This is all my own work.

I confirm that I am enrolled on a recognised UK course at Level 4 or above (not an access course).

I confirm that I have a UK bank account in my own name, for receipt of any bursary funds. If I receive a bursary, I will provide a written progress report for the Trustees by 31st July 2022. I understand that the funds must be used for the purposes I have set out above, or as otherwise notified and agreed by the Trustees, and the funds must be used before 30 September 2023.

I hereby give my consent for the holding and use of my personal data for the purposes of:

• assessing my application for a bursary award

• contacting me and my training provider/employer re eligibility and progress

• publicity (in the optical and local press, Twitter, Facebook, Instagram etc) about the bursary scheme

• contacting me about the work of the Company and The Spectacle Makers’ Charity and future membership of

The Worshipful Company of Spectacle Makers. (To change these permissions or withdraw consent at any time, contact charity@spectaclemakers.com)
Name
This field is for validation purposes and should be left unchanged.

Bursary Application Form 2021

Bursary Application Form 2021/22

Section A - Personal Details

Section B - Application Details