Norwich Theatre Take Part Bursary Application Form

Application Details

We have a limited annual fund, and are keen to help as many people as possible. The more you are able to contribute towards the cost of the activity, enables us to support more people.

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* 1. Course/Class/Workshop in which the bursary is sought for?

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* 2. Start date of Course/Class/Workshop

Start Date

Date

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* 3. Participants Full Name

First Name

Surname

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* 4. Participant's Date of Birth

DD/MM/YYYY

Date

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* 5. Participant Address Details

Name

Address

Address 2

City/Town

Postcode

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* 6. Parent/Guardian Contact Details (If the applicant is Under 18 this application must be filled in by a parent/guardian)

First Name

Surname

Email Address

Telephone No

Relation to participant

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* 7. Full Cost of the Course/Class/Workshop

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* 8. Please indicate how much your able to contribute to the cost of the Course/Class/Workshop (Our bursaries cover up to 40% of the full cost, more usually 25%)

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* 9. Please indicate how much assistance you are requesting

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* 10. Please detail your reasons for applying for a bursary

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* 11. Are you providing any supporting evidence with your application? (It is not necessary, but helpful to us, if you are able to supply any supplementary evidence to support your application, eg, letter of endorsement from doctor/social services. )

Yes

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* 12. If yes, Please upload your document below:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 13. Declaration (If the participant is under 18, a parent/guardian must agree to the terms below on behalf of the applicant)

I declare that the information given in support of this application is correct and complete to the best of my knowledge.

I understand that this information will not be shared with a third party, except for audit purposes

I understand that poor attendance, unauthorised absences, non-compliance or receiving a formal warning may result in loss of financial support

I give permission to Norwich Theatre to record the information in this form electronically for the purpose of monitoring the bursary funding