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Bursary Application Form

Pupil's Name:
Date of Birth:
Year/Term of Entry:

Parents (See Note 1)

Father/ Step Father/ Guardian Details:

Mother/Step Mother/ Guardian Details:

Capital Assets and Liabilities

Please enter below details of your Capital Assets and Liabilities, with all financial values shown in sterling. Please provide proof of all assets and liabilities e.g. bank statements.

All information provided will be treated in the strictest confidence.

 Father/Step Father/ GuardianMother/ Step Mother/ Guardian
a) Approximate market value of all investments
i) Building Society/Bank Deposits
ii) Equity Investments, Government Stocks
iii) PEPs, ISAs, NISAs, TESSAs
b) Approximate market value of principle residence
i) Is the property freehold or leasehold?
c) Approximate value of additional properties owned in UK
i) Approximate value of additional properties owned abroad
d) Approximate market value of other possessions including house contents, car etc.
e) Cash at bank or elsewhere (Current Accounts only)
f) Any other assets - please specify asset and give value

Capital Liabilities (See Note 3)

 Father/ Step Father/ GuardianMother/Step Mother/ Guardian
g) Mortgage - Amount outstanding
i) Mortgage - Final repayment date
h) Other liabilities (please specify)
Total Assets
LESS Total Liabilities

Current Earnings

Please enter below your current earnings and expected income from all sources for the tax year 2021 - 2022.

 Father/Step Father/GuardianMother/Step Mother/Guardian
a) Salary/wages
i) Gross
ii) Less Tax
iii) Less NI
iv) Benefits in Kind
b) Business profits/dividends (please give details)
c) Investment Income
i) Bank Interest
ii) Dividend Income
iii) Rental Income
d) Tax Credits/ Income Support
e) Maintenance Allowance received from previous partner
Total Income (Individual)
Deduct cost of living allowance (- 30,000)**
Deduct annual school fees for other pupils at the Foundation Schools (please give details)
Add fee support received from outside agencies (See Note 5)
Add fee support from other family members

** Should your cost of living be significantly lower than amount given above, please provide details as to why in the next section.

Additional Details

Please use this section to give more details where applicable.


After having read the attached notes, the following declaration should be signed by both parents/applicants.

(Please indicate if divorced/separated/widowed)

We/I have read the notes and have made a complete declaration of our/my income and assets.

We/I understand that if we are/I am offered an Award for our/my child and accept a place for him/her at the school:-
a) our/my child’s fees account with the School will be credited termly with the amount of the Award;
b) any award or grant is subject to annual review and we/I must complete an annual declaration of our/my financial circumstances on the form sent to us/me by the School and supply all relevant supporting evidence by the return date indicated;
c) we/I must undertake to report immediately any material change in the financial position declared;
d) the Award may be withdrawn or reduced, and in certain circumstances, past payment reclaimed if:

i) there is a breach of the School’s
Terms and Conditions attached to the acceptance of a place for our/my child at the school; ii) we/I have knowingly and/or recklessly provided false information;
iii) we/I have failed to return the annual declaration of our/my financial circumstances by the return date indicated;
iv) we/I have failed to produce any additional information required by the Charity to evidence our/my financial circumstances;
v) there is in the view of the Head either unsatisfactory work or conduct;
vi) the Charity’s resources are insufficient to maintain the level of Award

Terms of Conditions - Bursary Award Application Form

Before completing the form, please read these notes carefully, and contact the Clerk to the Governors if further information or advice is required.

The Charity reserves the right to seek any other documentary evidence in support of the income and asset figures submitted, and to make enquiries which it deems necessary.

All financial values should be shown in Sterling. References to Inland Revenue should include the relevant national Taxation Authority.


These are defined as:

- the natural father and mother of the child where they live together (whether or not they are married to each other) and the child normally resides with them both in the same household; or

- the parent of the child with whom the child normally resides and the partner (if any) of that parent where the partner normally resides with that parent and the child in the same household; or

- the child’s guardian appointed in accordance with section 5 of the Children Act 1989 (or any earlier enactment) and the partner (if any) of that guardian where the partner normally resides with that guardian and the child in the same household; or

- the person with whom the child resides in accordance with either:
i. a subsisting residence order made under section 8 of the Children Act 1989; or
ii. any subsisting court order (other than a residence order) which specifies who is to have actual custody or care and control of the child; or

- where a pupil either has no parents as defined above or the school is satisfied that no such parents can be found, and he is either looked after by a local authority or provided with accommodation within the meaning of section 105(1) of the Children Act 1989, the pupil shall be treated as one whose parents have no income for the purposes of the scheme; or

- where none of the above applies, the parent is the person with whom the pupil normally resides in accordance with any informal care or fostering arrangement and that person’s partner (if any) where the partner normally resides with that person and the pupil in the same household.

- If parents are separated or divorced before or while their child attends the School, both mother and father will be required to complete and sign the Application Form.


In addition to taking account of all relevant sources of income, the Charity takes account of the following assets:

- The capital sum of any monies on deposit with any bank, deposit taker or building society.

- Investments in stocks and shares, valued as near as possible to the date of submitting the application form.

- The current market value of your principal residence.

- If you run your own business or are partners in a business, then you should show the net worth of the business. Shares in a company not listed on a stock exchange should be valued at the relevant proportion of the net value of the company.

- In the case of second homes and/or other properties, these should also be included at their estimated current market value; no allowance will be made for any outstanding mortgage.

- Where the child has any unearned income, e.g. interest from National Savings, bank or building society deposits, or receives share dividends, you should enter the source of income and the gross amount received before deduction of any tax. You should enter the capital value of any beneficiary or other trust set up for each child.

- Where a Trust Deed has been drawn in favour of the child for whom you are applying, details of the annual amount available and the date of commencement of payment under the Deed should be given.


- Enter capital as well as interest payment on a mortgage for the principal residence.

- Include bank overdraft and other loan charges incurred during the year (specifying the purpose of the loan).

- Details of other liabilities should be provided along with the lender


- The gross annual amount of salaries and wages, including any earnings from profit related pay, part-time employment and any sum received as bonus, commission etc, statutory sick pay, statutory maternity pay giving GROSS amounts (before deduction of tax, NI, superannuation, etc) for the
2019/20 tax year.

- Taxable benefits in kind agreed with the Inland Revenue should also be shown (free or subsidised housing, meals, petrol, cars, etc) – at the amount agreed for taxable purposes.

- Profits from a business or profession – at the amount of GROSS income agreed by HMIT or relevant tax authority for the year in question (deductions should be made only in respect of capital allowances, losses and stock relief). Copies of the latest set of accounts should be included.

- All other Investment income (e.g. interest or National Savings Bank deposits; dividends, annuities etc) should be entered GROSS of tax. If tax were deducted at source, parents should add in the amount of tax paid or tax credit notified. Building Society interest must be disclosed GROSS.

- All social security benefits and tax credits received should be declared and type of benefit specified.

- Court Orders, Legal Separation Agreements and Voluntary Arrangements for School
Fees – Where a parent is required by a Court Order, or a legal binding separation agreement (e.g. Deed of Separation) to pay part of the School fees, then only that part of the fee which is not covered by the Court Order/agreement will be used to calculate any grant to be awarded. This is irrespective of whether or not the order or agreement is being complied with. Where the whole amount of the fees are required to be paid by virtue of a Court Order or separation agreement, applicants are not eligible for a grant. You should indicate how many years are payable and any annual variations. All receipts relating to maintenance payments, separation allowances and sums in respect of Child Support Maintenance must be declared.

- Enter income from letting or subletting of property at the amount of the NET profit agreed with the Inland Revenue; and royalties and all other sources including entertainment and travel allowances etc.


- Enter any other of your children who are unmarried and at a school, university or other educational institution which attracts a county grant.

- Members of HM Forces and Diplomatic Service should include the amount of any Education
Allowance which they receive. Parents in other occupations should include any similar sum.

- Insurance Policies for School Fees – If any insurance policy for the payment of School fees exists, then the amount declared is the amount receivable under the policy for the academic year for which the application is being made. If the insurance policy covers the full cost of the tuition fees, then the pupil is not eligible for a grant. The types of policy concerned are those which stipulate that the company shall pay the school fees, in whole or in part, to the school in respect of the pupil.


Please enter any details which may affect the assessment of an Award, e.g. a significant change in income or outgoings for the 2021/22 tax year