The John Mathews Educational Charity                                              Grant Application Form

Surname                                                                                               ------------------------------------------------------------------------------    

Forenames                                                                                           -----------------------------------------------------------------------------

Date of Birth                                                                                         ------------------------------------------------------------------------------

Home Address                                                                                     ------------------------------------------------------------------------------

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No of years resident at his address                                               ------------------------------------------------------------------------------

Are you on the electoral register for this address                      ------------------------------------------------------------------------------

Correspondence address ( If different to above)                        -----------------------------------------------------------------------------

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Telephone number                                                                              ----------------------------------------------------------------------------

Mobile number                                                                                      ---------------------------------------------------------------------------

Email Address                                                                                       ---------------------------------------------------------------------------

Place of Birth                                                                                          --------------------------------------------------------------------------

Have you, or a relative, previously applied to the charity for an award. Give details if Yes --------------------------------------

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Degrees / diplomas / Academic Qualifications already achieved. Please state university / college and dates awarded.

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What is your current / proposed course and university / college of study    ---------------------------------------------------------

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Is your current / proposed course full or part time. If PT how many hours per week and weeks per year.   -------------

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Date of commencement of current / proposed course (month & year)                                               ----------------------------

Date of completion (month & year)                                                                                                         ---------------------------------

How do you propose to fund your course (ie student loan, parental help, grant etc)       ----------------------------------------

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Please specify as fully as possible the costs of your course and any specialised materials or equipment required. Differentiate between expected course fees, materials, books and subsistence costs.

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Please provide details of your financial circumstances          ----------------------------------------------------------------------------

What level of support are you seeking from the Charity                                                               ------------------------------------

Are you receiving, or expecting to receive, funding from other sources. Please specify---------------------------------------

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What are your career aspirations after completion of the course.     -----------------------------------------------------------------

How did you hear about the John Mathews Educational Charity     --------------------------------------------------------------------

I confirm that the above information is accurate and fully reflects my current circumstances

Signature                                                                                               Date

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