First Name:

Last Name:

Email:

Prefix

Mobile Phone:

Street Address

Town / City

Postcode

Event Data

Date of Open Day / Audition / Event you attended

Location and Faculty

Proof of travel

Public transport receipt

Total Claim Amount

Proof of Eligibility

Applicants who are Care Leavers, Care Experienced, or Estranged. Applicants or their families who receive external financial support, such as Disability Students’ Allowance, a 16–19 Bursary, or Universal Credit, may also be eligible. Students who previously received Free School Meals are also eligible.

Proof of eligibility

Are you currently in receipt of the 16-19 Bursary?

Yes

Have you had experience of living in care, either as a care leaver or currently within looked-after care? For example, are you currently, or have you been, looked after by a local authority, in kinship or family care, or looked after at home under a supervision order for any length of time?

Yes

If you have answered Yes, are you happy to be contacted by our Designated Contact for Care Experienced students?

Yes

Do any of your parents, step-parents, guardians, foster parents or adoptive parents have any higher education qualifications, such as a degree, diploma or certificate of higher education?

Yes

If you have answered No, are you happy to be contacted by our Designated Contact for First in Family students?

Yes

Payment details

Please double-check that all payment details are accurate. We cannot be held responsible for any funds transferred to an incorrect account due to inaccurate information.

Account Name

Account Number

Sort Code

Bank Name

Intl Mobile Prefix API Name