Application

Application for Financial Assistance

Printable and e-mail version

Please return this form to:

The Northgate Foundation,
PO Box 1137,
Ipswich,
Suffolk IP1 9DH
Email: Northgate.Foundation@gmail.com

Please Complete all sections of this form

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Who is the Grant for?

Surname *

Forename(s) *

Address *

Post Code *

Date of Birth *

Contact Telephone Number (if any) *

Email:

Current School/Place of Study

Previous schools: *

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What will the grant be used for?

Purpose

Dates

How much are you requesting

Total cost of trip or equipment:

Family Contribution (required):

Amount requested:

Have you received any other grants/income for this project or any previous grants from the Northgate Foundation? If yes, please provide details:

How will the student benefit from the grant?

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Father

Name:

Address (if different from student):

Occupation:

Employer:

Mother

Name:

Address (if different from student):

Occupation:

Employer:

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Details of children living in the family home:

Name:

Date of birth

School/college

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Name:

Date of birth

School/college

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Name:

Date of birth

School/college

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Name:

Date of birth

School/college

You must prove that you meet at least one of these criteria:

Family income less than £23,000 per annum

Universal Credit Statement

Income Support

Income related Employment Support Allowance

Guarantee Element of State Pension Credit

Child Tax Credit (not working tax credit unless income less then £23,000)

Support under part IV of Immigration and Asylum Act 1999

*A copy of working tax credit statement showing income less than £23,000, or a copy of a letter or document relating to one of the other qualifying benefits.

No grant will be released unless proof of financial eligibility has been provided

Name of principal parent/carer (to receive contacts from us):

Signature of principal parent/carer:

The Northgate Foundation Supporting statement to be completed by the school

Thank you for helping us consider this application. If you have several children going on one trip, please provide only one copy of this form, unless you wish to draw a particular child’s circumstances to the attention of the Trustees.

Please provide answers to the following questions:

How many children are going on the trip?

How big is the year group/cohort?

Are you using pupil premium money or school funds in support of the trip?

If so, how much per pupil?

How many of the children in the cohort are receipt of free school meals?

Please provide below a brief summary of the nature of the activity and the way in which it will benefit the pupils:

Your name:

Position:

School:

Email contact:

Telephone contact:

If you are human, leave this field blank.

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Proof of eligibility

No grant will be released unless proof of financial eligibility has been provided. You must include one of the following:

• A copy of working tax credit statement showing family income less than £23,000, or
• a copy of a letter or document relating to one of the other qualifying benefits.

Deadlines for applications

Applications must be received by:

• the Friday before the October half term holiday for school trips taking place in the Spring term 
• the Friday before the February half term holiday for school trips taking place in the Summer Term
• the Friday before the May half term holiday for school trips taking place in the Autumn term

Application received after these dates will automatically be deferred to the next half term.

If this application arises from activities at a school or college, Part B of this form must be completed. Requests for School/College/University equipment/materials/uniform, Part B does not need to be completed.