16 - 19 Bursary Application Form

Learner Details

1. Surname / Family Name *
2. First name(s) *
3. Date of Birth (dd/mm/yyyy) *
4. Age on 31st August 2024
(You must be aged 16, 17 or 18 on 31st August 2023 to apply)

Address Details

1. Home Address *
2. Postcode
3. Home Phone Number
4. Mobile Phone Number

5. Enter Email Address 

E-mail:

Financial Information 

1. Are you and / or your sibling(s) in receipt of free school meals?
2. Please enter sibling name(s)

Household Members

1. Select number of household members responsible for household bills (up to 2 people)

Person 1

Surname
First name(s)
Relationship to Learner
Contact Number:
Are you employed (YES / NO)
If yes, please upload P60:
If you are not employed, please tick the relevant options to indicate the benefit(s) you receive:
Please tick the relevant boxes to indicate all other income received into the household
Any other income / benefit – please specify (see above question) - leave blank if not applicable

e.g Disability Living Allowance
Employment Support Allowance

Person 2 (If you have a second person)

Surname
First name(s)
Relationship to leaner:
Contact to learner
Are you employed:


If YES please upload your P60.
If you are not employed, please tick the relevant options to indicate the benefit(s) you receive:


Please tick the relevant boxes to indicate all other income received into the household
Any other income / benefit – please specify

Evidence

Whatever you have declared in the sections above must be backed up by evidence (photocopies accepted) in order for an assessment to be made

The tables below show the evidence you will need to provide with your application form.

Type of Income

Evidence Required

Annual Salary

P60 for tax year 2023-24, or week 52 (last week in March 2024) payslip or month 12 (March 2024) payslip

Universal Credit

Entitlement / Award letter – dated within the last 3 months

Income Support

Entitlement / Award letter – dated within the last 3 months

Job Seeker’s Allowance

Entitlement / Award letter – dated within the last 3 months

Employment Support Allowance

Entitlement / Award letter – dated within the last 3 months

Incapacity Benefit

Entitlement / Award letter – dated within the last 3 months

Housing Benefit

Entitlement / Award letter – dated within the last 3 months

Council Tax Reduction

Entitlement / Award letter – dated within the last 3 months

Any Other Benefit

Entitlement / Award letter – dated within the last 3 months

Working Tax Credit

Working Tax Credit Award Notice marked “2023-24”. Must be for full year and not partial awards (FULL AWARD NOTICE).

Child Tax Credit

Child Tax Credit Award Notice marked “2023-24”. Must be for full year and not partial awards (FULL AWARD NOTICE).

Personal Independence Payment

Entitlement / Award letter – dated within the last 3 months

Grants, Awards, Bursaries, etc.

Relevant paperwork detailing entitlement and amount paid

Any other income

Relevant paperwork

Once you have declared and identified your benefits on the application, find ‘Type of Income’ that applies to you in the first column and the ‘Evidence Required’ column will tell you what you need to provide. You may either bring in photocopies of these into school or upload in the below section.

Please be aware we must receive evidence in order to process your bursary request. 

Please upload your evidence.

Declaration

Please read the declaration below and read carefully before signing:


1. I declare that the statements made on this form are true and to the best of my knowledge and belief are correct in every respect. I undertake to supply any additional information that may be required to verify the particulars given. I understand that if I refuse to provide information relevant to my claim the application will not be accepted. I also undertake to inform the school of any alteration to any of the particulars in writing. I agree to repay the school in full and immediately any sums advanced to me if the information I have given is shown to be false or deliberately misleading.

2. I am aware that the funding covers only this school year and that I must re-apply next year; there is no guarantee that I will receive funding for future years even if I am eligible for the current year.


Signed (Learner)
Date of signature

Person 1 or 2

Signed (Person 1 or 2)
Date of Signature (Person 1 or 2)

Bursary Bank Details and What the Bursary will be used for

Please complete this form so that your first payment can be set-up to pay and confirmation what your bursary will be used for with estimated amounts below.


Bank Details
Account Name
Bank Name
Bank Sort Code
Bank Account Number



Use of burary funds

The bursary award amount will be confirmed with your bursary application confirmation and paid in 3 payments paid directly into your bank account at the start of each term. The first payment will be made once your bursary has been confirmed. Receipts for items purchased must be handed in or emailed to our Finance Team (finance@sghs.org.uk). It is important to send receipts to finance as items are bought so they can be kept with your bursary record.


Please confirm further details of how you will be using the bursary funds and the amounts. 

The four main areas that the SGHS bursary can be used to support sixth form students are:

Transport costs to and from school: £
Meal costs: £
Laptop scheme: £
Fieldwork/school trips: £
Books: £
Other: £

Final Submission 

Please complete this form and bring receipts for items you have already bought to the Finance Office (top floor of the house) or email to finance@sghs.org.uk with your scanned receipts and then drop off original receipts to the finance office.


If you have any queries on your bursary over the year, please see the finance team or email us finance@sghs.org.uk. Thank you

Send me a copy of this form

Please leave the next box blank or your submission will not be accepted: