The Pyrus Trust Bursary Scheme Application Form 2015/16




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The Pyrus Trust Bursary Scheme Application Form 2015/16

Please note that any false information given will result in the repayment of any monies received. PLEASE COMPLETE THIS FORM AS FAR AS POSSIBLE.

Please refer to the accompanying information sheet for further information about the scheme.


Student number: ____________________
Full Name: ____________________________________________________________________________
Date of Birth: ___/___/____ (DD/MM/YYYY)
Course and year of study at the University of Brighton: ______________________________________
Details of time spent in care

Please give brief details below of which local authority or responsible body you were in the care of (e.g. local authority, foster care or residential children’s home) and the approximate dates involved. We do NOT want you to disclose anything about the circumstances surrounding your time in care. We just need to establish that you meet the eligibility criteria.


Please state which local authority you were in care with:


______________________________________________________________________________________

______________________________________________________________________________________


Dates or period in which you were in local authority care:


______________________________________________________________________________________

______________________________________________________________________________________

We will need to contact the local authority to verify you were under their care. Do we have your permission to do this? YES / NO
Please provide the name and contact details for your social worker:
_____________________________________________________________________________________


_____________________________________________________________________________________


If you have any further information that you would like to let us know please do so here:



_____________________________________________________________________________________

_____________________________________________________________________________________





By signing below I confirm the above information to be true.
Signature: __________________________ Date: ____________________________

Please return by Friday 6 November 2015 to:

Michelle Tarling (Widening Participation Outreach Manager).

By email attachment: m.tarling@brighton.ac.uk
By post: Academic Services, University of Brighton, Watts House, GA Ground Floor, Lewes Road, Brighton, BN2 4GJ


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