The Dempster Trust Application Form

Personal and course information

Forename *

Surname *

Date of birth

Email address *

Confirm email address *

Address line 1

Address line 2

Town/City

County

Postcode

Home telephone number

Mobile telephone number

Total weekly income

Evidence of income (wage slips, benefits letters, etc.)

Upload scanned wage slips or evidence of benefits received. You can select multiple files (PDF, JPG, PNG, GIF).

Are you registered disabled or are you a carer? Are there any other circumstances that would help your application?

Course of enrolment date and details *

Supporting staff member

A Senior member of your University or Educational establishment staff able to verify your situation.

Name *

Position *

Email address *

Telephone number

Bid for support

Please outline the materials/equipment you would like us to purchase for you if your application is successful. For each item, include the name of the equipment, the price and where it can be purchased from, and a brief outline of how it will benefit your studies.

Supporting statement

Give us a brief overview of your current study practices and what you hope to achieve through your studies. Please also tell us why you should be given a grant to help you in your studies.

Declaration

I confirm that the above information and details are correct.
I agree to The Dempster Trust collecting, using, storing and sharing your personal information in accordance with our Privacy Policy.