Application - 18 & Over

Complete the following form

You will be emailed a copy of your form when you have completed. You can also attached scans or photos of any supporting documents.

Step 1 of 5

20%

Part One - Personal Details

Please provide your full name and address, please note if you still reside in the parental home or with a spouse/partner/other further household information.

Your Name

Date Of Birth

DD slash MM slash YYYY

Address

Street Address Address Line 2 Town / City Post Code

Telephone

2. What would you like financial assistance for?

Please give us a brief description.

Please provide the total cost and the specific amount of funding you require from the Foundation (if different please explain, in the brief description area above, how the difference between the funding required and the total cost will be met).

Total Cost

Amount Of Funding Required

Please provide evidence/ paperwork regarding any funding cost you are looking for. You can either attached a scanned document or PDF, or take a clear photo of the document(s) and upload them.

Supporting Files For Funding

Drop files here or

Accepted file types: pdf, png, jpg, jpeg, doc, docx, Max. file size: 64 MB.

(If on a phone, you can also use your camera. Click the "Select Files" button.)

Relevant information for Uploads

3. Supporting Financial Documentation

You will need to provide documentation below for any personal income and/or benefit. If you do not live independently, you must also supply household income and/or benefits.

If you have Student Finance England funding you must provide full details of funding received.

Supporting Files For Income

Drop files here or

Accepted file types: pdf, png, jpg, jpeg, doc, docx, Max. file size: 64 MB.

(If on a phone, you can also use your camera. Click the "Select Files" button.)

Relevant information for Income Uploads

4. About You

Include how the award you are seeking will benefit your current education, your higher education goals, or future career aspirations/prospects. Provide details of; the qualifications you have already attained, where and what qualification you are currently studying for, any extracurricular activities you do that benefit your studies or the wider community, any other funding or fundraising you have received/embarked upon and finally, any extenuating circumstances or achievements you feel relevant to your application.

About You

Supporting Files. EG. References, and other supporting documents.

Drop files here or

Accepted file types: pdf, png, jpg, jpeg, doc, docx, Max. file size: 64 MB.

(If on a phone, you can also use your camera. Click the "Select Files" button.)

5. Declarations

To be completed by Applicant.

Form Information

I confirm that, to the best of my knowledge, the information on this form is correct and complete.

I accept that false information may result in my application being disqualified.

Residence / QMC Study

I confirm I live in Basingstoke, am a current student or studied for at least one year at Queen Mary's 6th Form College, Basingstoke.

You are confirming that you currently live in the borough of Basingstoke and Deane and/or that you are currently or have been a student of Queen Mary’s College Basingstoke for at least one year.

Residence / QMC Study

Third Party Consent

You are confirming any information or documentation relating to a third party and supplied, by you, to the Foundation in support of the application has been provided with their full knowledge and consent and will be used only for the sole purpose of assessing this application.

I agree to photographic images and/or any subsequent award detail being made public on the Foundation website and/or social media pages

Yes

Your Signature

Please draw your signature clearly. We may require a proper signature further into the process.

Date

DD slash MM slash YYYY

Application - 18 & Over

Complete the following form

Part One - Personal Details

2. What would you like financial assistance for?

3. Supporting Financial Documentation

4. About You

5. Declarations

To be completed by Applicant.

Contact Us

Phone

Email Us

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