Data Protection Statement
The information collected on this form will be used in compliance with Data Protection regulations. By supplying this information, you are giving your consent for it to be lawfully processed for educational purposes. Your privacy is important to us and all information will be kept securely, however, we may disclose the information, as appropriate, to the Department for Education, and other relevant statutory bodies as indicated in our Privacy Notices. The information on this form will be processed electronically and stored securely in the school’s Management Information System. Your personal information will be retained in line with our Records Management and Retention Policy after which time it will be securely destroyed. If there are any changes in your circumstances which could affect the accuracy of the data we hold on you please contact us so that we may update your personal information accordingly.
Email address *
Please note the following important information:
• You should read the 16-19 Bursary Fund Policy 2020-21 to make sure you are eligible to apply:
• Please complete all sections of the form and make sure you provide us with copies of the evidence we need. Your
application will not be assessed without the correct evidence. Please note that we cannot take any responsibility for
evidence that is sent to us by post.
• The closing date for autumn applications is Monday, 28th September 2020, however, applications received after this date
will still be considered.
• The budget we have available is limited so we cannot guarantee that we will be able to provide you with the financial
support you request
• Payments of all bursaries are dependent on you maintaining attendance of 90% or above on all your courses, behaving
appropriately and adhering to the conditions set out in the Plantsbrook School Sixth Form Learning Agreement.
. All awards will depend on the funding the School receives from the Government. No assumption should be made that you
will get funding and the School reserves the right to stop and remove funding at any time.
. You must have your own bank account in order to receive Bursary payments. Payments will be made by BACS and will
need to be paid into your bank account and not a third party one. Failure to provide bank account details will cause your
Bursary Fund to be withheld.

First Name *
Surname *
Tutor Group *
Date of Birth: *
Current Address: *
If you do not live with your parent(s)/guardian(s) please give details of their name(s) and address(es):
Home Telephone Number: *
Student's Mobile Telephone Number: *
Student's Email Address: *
Please tick which of the following applies to you: *
Have you been resident in the UK or EU/EEA for the last 3 years? *
Do you have your own bank account? *
Name of student's bank (i.e. Nat West): *
Name of student's bank account: *
Bank account number: *
Bank sort code: *
Vulnerable Student Awards: Are you, (the student): *
Please tick as appropriate:
Are you, or your parents/guardians in receipt of one or more of the following benefits (please tick all that apply):
Are you or your parents/guardians not in receipt of one of the benefits listed above but are employed or self-employed with a gross household income of less than £21,000 (including any tax credits)?
Clear selection
Have your parents/guardians been affected by redundancy in the last 12 months?
Clear selection
Are you a young carer?
Clear selection
There may be other costs than those identified below which occur throughout the year, e.g. travel to University visits, Open Days, interviews, subject trips, school trips. You will not know these costs at the time of completing this application so at present we will only consider support in relation to the questions asked below. If you have other School-related costs in the future, then you will need to contact the Sixth Form Office. What subjects will you be studying in 2020/21? *
Do you live more than 2 miles from school and need help with travel costs?
Clear selection
Do you need help with funding for school uniform/specialised subject clothing? (please specify)
Do you need help with funding for equipment for your chosen subjects (please specify)
Please use this space here to give us any additional information you think may support your application:
You must now email evidence to support your application to: finance@plantsbrookschool.co.uk Please see the policy for examples of evidence that you can include. https://plantsbrookschool.co.uk/finance-bursary/ For some students evidence may be an email from the Head of Sixth Form to support your application. *
I certify that the information given is, to the best of my/our knowledge and belief correct. I understand that payments may be delayed or stopped if I, the applicant, do not maintain the minimum requirement of at least 90% attendance on all of my courses. I undertake to inform Plantsbrook School immediately if I, the applicant, decide to leave my course. I understand that if I leave my course of study before completion, Plantsbrook School may attempt to re-claim any monies allocated. I understand that the information provided on this application may be shared with other departments at Plantsbrook School. *
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