Duchess Application 2015-16

Application Form

Part A: to be filled in by applicant

Surname Christian Name

Religion Date of Birth

Email

Tel. Mobile

Home Address (if the above is not in the Fund's catchment area)

Charity no. 529620

1

Address for correspondence

Postcode

Postcode Tel.

(For applicants under the age of 18) The name of a parent or guardian is required as evidence of their consent to both this application and your proposed course or experience

Name of parent or guardian

I confirm that I agree to my daughter taking part in the project/experience/course for which she is seeking funding.

Date

Duchess Application 2015-16

Please tell us about yourself 1 Education

2 Employment or Work experience

3

Please tell us about your project

What is the Project or Course etc. for which you are applying for funding? (Lourdes applicants please give details of the group you will be travelling with; omit QQ 6 and 7and go directly to Q 8)).

6.

Dates of your proposed visit:

a. to

b. to

2

Short Courses (under a month): From

Longer courses: From

Please give full details of your proposed project/course including, for residential courses, the name and address of the institution where you will be staying (use a continuation sheet if necessary) (If you can include with your application copies of any information you have about your proposed destination, please do so.)

4.

5.

Your skills and interests (e.g. proficiency in music, language, sports, driving, or skills derived from hobbies)

Duchess Application 2015-16

7. What is the estimated cost of (a) travel

(b) living expenses

(c) other expenses (please specify)

8. What is the total cost of your project?

9. How much are you able to contribute to it yourself and/or from other sources?

How much are you applying for from the Fund?

3

10. Have you received grants from the Duchess Fund in previous years? Please give details of year,project and amount of money received;

11. Have we received a Report from you for each of the projects for which we gave you a grant?If not, please explain why.

Signature Date

Please forward DuchessSponsor_Online_2014-15 to your parish priest, or other equivalent person and ask them to complete and return it. If they prefer to fill in the print version of the form, please download it from our website: www.duchessfund.org.uk and give it to them with a stamped addressed envelope.

When you have completed the form, go to the file tab and click on save as. Change the file name to your name(e.g. Mary Jones)-DuchessApplication and return it without delay to : duchessfund@assumptionreligious.org

If you are applying as part of a school or youth group, send the form to your group organiser at the email address they give you. They will be responsible for completing the Sponsor form and sending the batch of applications to us.

4

Please tell us what you expect to gain from the visit or course proposed (approximately 250- 450 words(Please note that the Committee considers what you say here very carefully.)

Name

Duchess Application 2015-16