Bursary Application Student DetailsName of student* First Last Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Last Course AttendedName and date of course to be attended in the current academic year*Instruments for which a bursary is required*School attended*State or independent?*StateIndependentParental detailsName of parent(s)*Home Address* Street Address Address Line 2 City Postcode Main contact phone number*Main contact email address* Financial detailsExpenditure on music tuition per annum*Father's occupation*Father's Gross Annual Salary*Mother's occupation*Mother's Gross Annual Salary*Gross Annual income from Property*Gross Annual Income from Savings*Total Net Annual income after tax including the above plus any other income*Total value of savings, excluding pensions*Total value of properties owned*Number of dependent children (under 18)*Bursary detailsReason for seeking a bursary*Describe what attempts have been made to secure funding from elsewhere and the result of these attempts*Any other circumstances you wish to bring to our attentionPro Corda reserves the right to request evidence of income and outgoings as set out in this form and to seek further clarification from applicants as necessary. In accepting bursary support, your child agrees to submit a report of their course experience and/or an acknowledgement to the relevant charitable trust as part of Pro Corda’s reporting requirements. Any reports must be submitted to Pro Corda within one month of the course ending. You accept liability for the full course fees if this is not adhered to. Failure to fill out this form in its entirety will prejudice your application for a bursary.DeclarationFather's Consent* I accept the conditions set out in this formI accept all of the conditions set out in this document. I declare that, to the best of my knowledge and belief, the information given is correct and it is a true representation of my financial circumstances. I authorise Pro Corda to disclose and discuss with relevant third parties any information provided on this form.Mother's Consent* I accept the conditions set out in this formI accept all of the conditions set out in this document. I declare that, to the best of my knowledge and belief, the information given is correct and it is a true representation of my financial circumstances. I authorise Pro Corda to disclose and discuss with relevant third parties any information provided on this form.
