BURSARY APPLICATION FORM

2022 – 2023

Pupil’s Name:* Date of Birth:* Year of Entry* Term of entry*

Parents

(See Note 1)*
	Father/Step Father/Guardian	Mother/Step Mother/Guardian
Name:
House/Apartment number:
Address (line 1):
Town / City:
Post code:
Telephone Number:
E-mail:
Occupation:

Other Dependants:

(See Note 5 – please give details) Any other relevant information:

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. statements. All information provided will be treated in the strictest confidence.

If an asset or liability is shared please split the value appropriately for example if you and your partner own a house equally together valued at £140,000 please input £70,000 for each of your responses

Capital Assets

(See Note 2)
	Father/Step Father/ Guardian*	Mother/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
Approximate market value of principle residence (eg: freehold, leasehold & Value)
Approximate market value of additional properties owned (UK and/or 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)

Please give details of any capital charges against the assets declared above
	Father/Step Father/ Guardian	Mother/Step Mother/Guardian
g1) Mortgage (Amount Outstanding)
g2) Mortgage (Final repayment date)
h) Other liabilities
Total Assets
LESS Total Liabilities
NET ASSETS

Current Earnings

Please enter below your current earnings and expected income from all sources for the tax year 2020 – 2021.
Please provide proof of income for all sources e.g. tax certificate, P60 etc.

Income sources (See Note 4)
	Father/Step Father/ Guardian	Mother/Step Mother/Guardian
a) Salary/wages
i) Gross
ii) Less Tax
iii) LessNI
Net Salary
iv) Benefits in Kind
b) Business profits/dividends (please give details)
c) Investment Income
i) Bank Interest
ii) Dividend Income
iii) RentalIncome
d) Tax Credits/Income Support
e) Maintenance Allowance received from previous partner
Total Income

Combined Income

Combined Income 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
FUNDS REMAINING FOR CONTRIBUTION TO SCHOOL FEES

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

Please use this area to give more details where applicable. Please also give details if you are aware of any details for the next financial year that will materially affect your ability to pay.

Declaration

After having read the attached notes, the following declaration should be signed by both parents/applicants (please indicate if*MarriedDivorcedSeparatedWidowed

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

our/my child's fees account with the School will be credited termly with the amount of the Award;
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;
we/I must undertake to report immediately any material change in the financial position declared;
the Award may be withdrawn or reduced, and in certain circumstances, past payment reclaimed if:
1. 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;
2. we/I have knowingly and/or recklessly provided false information;
3. we/I have failed to return the annual declaration of our/my financial circumstances by the return date indicated;
  we/I have failed to produce any additional information required by the Charity to evidence our/my financial circumstances;
4. there is in the view of the Head either unsatisfactory work or conduct;
5. the Charity's resources are insufficient to maintain the level of Award

We/I understand the above statements*tick to confirm

Signature

Parent #1

*Please tick to confirm and sign the above.

Parent #2

Please tick to confirm and sign the above.

Documentation

Please upload the following documents:

Proof of all sources of income, this might be (but is not limited to) your most recent P60, tax certificate or business accounts.
Proof of all capital assets, this might be (but is not limited to) bank/building society statements showing balances, statements for PEPs, ISAs, TESSAs and NISAs or Investment stocks.
Proof of all debts, this might be (but is not limited to) overdrafts, credit agreements (including credit cards) or outstanding mortgage statements.

Please place all of your supporting documents in one folder, zip (compressed) it and then upload the folder by clicking ‘Choose File’ and selecting your zipped file. No file chosen

King's High Warwick