Francis Courtney Educational Fund – Grant Application Form

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Applicant

Please confirm which of the following statements represents your position regarding this application:*

I am the grant awardee
I am applying on behalf of the grant awardee
I am applying on behalf of an Organisation

Have you made a previous application to the Francis Courtney Educational Fund?*

Yes
No

Previous Application(s)*

Year	Amount	What was it for?

Personal Details of Grant Awardee

Full Name of Grant Awardee*

First Name Last Name

Does the Grant Awardee live within the London Borough of Ealing?*

Yes
No

You need to live within the London Borough of Ealing to be eligible for this grant.

Sorry, only residents from the London Borough of Ealing are eligible for funding from this grant. Please check the full funding criteria.

Email Address of Grant Awardee*

Enter Email Confirm Email

Home Address of Grant Awardee*

Street Address Address Line 2 City Post Code Country

Correspondence Address of Grant Awardee

Same as Home Address

Street Address Address Line 2 City Post Code Country

Mobile Phone Number of Grant Awardee*

Date of Birth of Grant Awardee*

Details of Person Making The Application on Behalf of Grant Awardee

Full Name of Applicant*

First Name Last Name

Email Address of Applicant*

Enter Email Confirm Email

Home Address of Applicant*

Street Address Address Line 2 City Post Code Country

Mobile Phone Number Applicant*

Education and Training of Grant Awardee

Name of School for GCSEs*

GCSE Subjects studied and grades achieved*

If no grades achieved, please enter 'N/A'.

GCSE Subject	Grade

Name of School or College for A'Levels or other further education, if different

A Level Subjects studied and grades achieved (or projections)

A Level Subject	Grade

Higher Education Qualifications

Subject/Course	Location	Year

Other Qualifications

Subject/Course	Year	Grade

Future study plans

Please provide details of any plans you have for further, future study.

Career plans

Please provide details of any career plans you have

Organisational Details

Name of Organisation*

Your Title/Position within the Organisation*

Are you a registered charity?*

Yes
No

Registered Charity Number*

Objectives of the Organisation*

Are the beneficiaries of the organisation resident within the London Borough of Ealing?*

Yes
No

The beneficiaries of the grant need to live within the London Borough of Ealing for the organisation to be eligible for this grant.

Sorry, only organisations whose beneficiaries are resident in the London Borough of Ealing are eligible for funding from this grant. Please check the full funding criteria.

Estimated number of people who will benefit from this grant*

Please enter a number from 1 to 1000.

Minimum age of people who will benefit from this grant*

Please enter a number from 0 to 24.

Maximum age of people who will benefit from this grant*

Please enter a number from 1 to 24.

Purpose of the Award

Total amount of grant funding you are applying for:*

Please enter a number from 1 to 1500.

Which of the following will the grant funding be used for?*

Please give full details of the course for which you are applying for funding:*

Course Title	Location	Qualification

Please explain why you wish to do this course:*

Please list all costs associated with this course:*

Item	Cost

Why do you need this equipment?*

Please list the individual equipment items and their costs*

Item	Cost

Please describe what the grant will be used for:*

Please list the individual items and their costs*

Item	Cost

Please describe what your organisation will use the grant for:*

Please list the individual items and their costs to your organisation:*

Item	Cost

Financial Information

Financial Circumstance*

Funding is intended to help those in greatest financial need. Please give details of Grant Awardee's or beneficiaries financial circumstances and need for funding.

Whilst attending school were/are you (or the Awardee if applying on their behalf) eligible for free school meals or ‘pupil premium’?*

Yes
No

Which were you eligible for?*

Free School Meals
Pupil Premium

You can select both

Whilst under 18 were/are you (or the Awardee if applying on their behalf) a ‘looked after child’?*

Yes
No

Please give details of any finances you (or the Awardee if applying on their behalf) are contributing to the overall cost of the course/project:*

Please give details of any finances your organisation (or the beneficiaries) are contributing to the overall cost of the course/project:*

Please list any other confirmed sources of funding towards this need:

Funding Source	Amount

References

Please give the names and details of two referees in support of your application. If applying as an individual, one should a teacher or tutor who is aware of your financial circumstances. The second should know you other than at school, for example, a church leader, employer or an adult who knows you well (but is not related to you) and is able to make an assessment of your financial need for the grant. If applying as an organisation, please provide referees who know of your organisation but are not directly involved. We will contact at least one of your referees, so please tell them that they may be asked to provide a reference for you.

Referee 1 - Full Name*

First Last

Referee 1 - Email*

Enter Email Confirm Email

Referee 1 - Position/Role:*

Referee 1 - Phone*

Referee 1 - Address*

Street Address Address Line 2 City Post Code Country

Referee 2 - Full Name*

First Last

Referee 2 - Email*

Enter Email Confirm Email

Referee 2 - Position/Role:*

Referee 2 - Phone*

Referee 2 - Address*

Street Address Address Line 2 City Post Code Country

Declaration

Declaration of Authority & Honesty*

I declare I have the authority to represent this individual or organisation in making this application and the information provided is accurate and correct. I understand that if I have given any misleading or false information on this form my application may not be progressed.

Data Processing & Privacy Consent*

I consent to the data provided in this form being processed and shared with Pathways Housing Committee, in line with our privacy policy.

Submit Form or Save Form

Once complete, you can submit the form. Any missing required information will be summarised at the top of the form. You can also tap 'Save and Continue' which allows you to continue the form at a later time/date. We send you a unique link that expires after 30 days. Please be aware that after tapping the 'Save & Continue' button, you ALSO need to provide the email address you'd like the Link sent to and then tap the blue 'Send Link' button.

Francis Courtney Educational Fund – Grant Application Form

The Francis Courtney Educational Grant Application Form is currently unavailable. It will be available next between 1st June and 31st August.

Applicant

Personal Details of Grant Awardee

Details of Person Making The Application on Behalf of Grant Awardee

Education and Training of Grant Awardee

Organisational Details

Purpose of the Award

Financial Information

References

Declaration

Submit Form or Save Form

Contact Pathways about Independent Living Accommodation

Contact Details