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CRICHTON FOUNDATIONAPPLICATION FOR STUDENT FUNDING
You must complete all sections and use the checklist to ensure all of the information requested is submitted. Please note that all correspondence will be sent to your student email address.
First name SurnameStudent ID Number Student EmailHome address Term address (if different)
Telephone MobileDate of Birth Marital/Civil StatusNo. of dependants Age(s) of childrenInstitution Course Year of studySchool attended
College attended
Existing qualifications
CHECKLIST Supporting documents enclosed (copies please as original documents will not be returned)SAAS Award letter (both sides)Latest bank statements please highlight the following:
Wages/Salary Tax Credits Award Benefits (including Child Benefit) Rent/Mortgage payments Debt repayments, loan repayments, credit card payments
Academic transcript or printout of most recent grades achievedReference from course tutor or adviser of studies
Office use onlyAcademic Excellence
Carson Reaching Potential
Crichton Vision Award
General Application
Previous awards
Page 1 Page 3
Amount awarded Cheque number
ID checked Date issuedI confirm I have received payment of the above award from the Crichton Foundation
Signed Date
June 2015 1
Supporting StatementPlease use this space to provide further information on your circumstances and explain how this support will help you with your studies, for example details of additional course costs for field trips or similar.
June 2015 2
Income and expenditureMonthly Income Self Partner Monthly expenditure
(include partner’s expenditure where applicable)SAAS funding
Hou
sing
C
osts
Mortgage/Rent
Student Loan Council Tax
Employment income Buildings/Contents Insurance
Job Seeker’s Allowance
Bill
s
Utility BillsEmployment & Support Allowance Television Licence
Housing/Council Tax Benefit Home Tel./TV/Broadband
Child Benefit Mobile tel. (no. of mobile phones in household ____)
Tax credits Groceries (food, housekeeping, toiletries etc.)
Grant/Bursary/Scholarship/Trust income (detailed below)
Debt repayments (detailed below)
Parental contribution
Trav
el
cost
s
Car Insurance and Road Tax (no. of cars in household ____)
Other income (detailed below) Car fuel costs
Public Transport Costs
Oth
ers
Course costs(books, stationery etc.)Tuition fees
Child Care
Clothing/Shoes
Applicant’s total income Entertainment
Partner’s total income Other expenditure(detailed below)
Total Monthly Household Income Total Monthly Expenditure
Total monthly income minus total expenditure equals monthly excess/shortfall
Total savings and investments
Additional Income and Expenditure InformationPlease use this space to provide additional information on income and expenditure to support your application, details of outstanding debts and information on how you intend to fund your studies
June 2015 3
CRICHTON FOUNDATIONAPPLICATION FOR STUDENT FUNDING
This Application Form should be used by individual students applying to the Crichton Foundation. Information about the awards and grants available can be found on the Foundation web site (www.crichtonfoundation.org). If you would like to discuss your application please contact us to arrange a convenient appointment.
It is your responsibility to ensure all supporting information is received at the Foundation office prior to the deadline for consideration at the next Awards and Grants Committee meeting, details of which are available on our web site. All correspondence from the Foundation relating to your application will be through your student email (home, work or private email addresses will not be accepted).
All information you supply with your application will be treated in the strictest confidence and stored securely. Crichton Foundation staff, members of the Awards and Grants Committee and Student Services staff are the only people who will have access to your application. Limited details of your application may be discussed with your course tutor or adviser of studies if this is necessary to support your application. Your personal information will not be disclosed to any third party.
Successful applicants will be required to submit a very brief report to the Awards and Grants Committee stating how the funding has helped with their studies.
By submitting this application you are confirming that information provided is accurate and complete.
Please return your completed form by email to:
If you are unable to submit you application electronically you may submit your application to:
Awards and Grants CommitteeCrichton FoundationBrowne HouseBankend RoadDumfries DG1 4ZZ
If you have any questions about your application please contact us by email or telephone:
Tel: 01387 702047 or 702048
Please keep this page for your records.
June 2015 4
