The Richard Ely Trust

T H E R I C H A R D E L Y T R U S T

F O R Y O U N G M U S I C I A N S Registered Charity no 1085780

APPLICATION FOR FINANCIAL ASSISTANCE

Please complete all sections of this form before returning it, together with the separate endorsement, to the Richard Ely Trust for Young Musicians, 27 Ashmeads Close, Wimborne, Dorset, BH21 2LG

Deadlines for the receipt of applications are the end of March, June, September and December. Applications after the deadline will only be considered at the next scheduled meeting of the Trust. All applications must be accompanied by a teacher's report where applicable.

Unless a specific request is made, support will be given for a period of 12 months. Grants are usually in the range of £85 to £300 towards the cost of lessons or approved trips or fees.

In the case of a child under 12, the parent/carer may wish to complete the form for the child.

Section A - About you and your Music

Surname (please print)……………………………………First Names………………………………………………. Address…………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………… …………………………………………. ……………………………………………………………………………………..Post Code……………………………….. Date of Birth………………………………………….Telephone No……………………………………………………………. Email……………………………………………………………………….. Name of School or College you are attending, or last attended …………………………………………………………………………………………………… …………………………………………….. Details of your instruments:- Instrument Grade achieved How long have you been learning?

Patrons: Marin Alsop; Natalie Clein; The Lady Digby DBE DL; Dame Emma Kirkby OBE; Jennifer Pike. Trustees: Christine Dipple; Vicky McDonaugh; Nichola Gunn; Malcolm Lofts; John Nash; Lisa Tregale. …………………………………………………………………………………………………… …………………………………………….. …………………………………………………………………………………………………… …………………………………………….. …………………………………………………………………………………………………… …………………………………………….. …………………………………………………………………………………………………… …………………………………………….. …………………………………………………………………………………………………… …………………………………………….. Please give us a brief description of your musical interests and activities

…………………………………………………………………………………………………… ……………………………………….. …………………………………………………………………………………………………… ……………………………………….. …………………………………………………………………………………………………… ……………………………………….. …………………………………………………………………………………………………… ……………………………………….. …………………………………………………………………………………………………… ……………………………………….. …………………………………………………………………………………………………… ………………………………………..

Section B - About Your Application What sum of money are you applying to us for? £………………………. For what purpose will this money be used?...... …………………………………………………………………………………………………… …………………………………………

Patrons: Marin Alsop; Natalie Clein; The Lady Digby DBE DL; Dame Emma Kirkby OBE; Jennifer Pike. Trustees: Christine Dipple; Vicky McDonaugh; Nichola Gunn; Malcolm Lofts; John Nash; Lisa Tregale. …………………………………………………………………………………………………… ………………………………………… …………………………………………………………………………………………………… ………………………………………… What do you expect the benefits to be to you?...... …………………………………………………………………………………………………… ………………………………………… …………………………………………………………………………………………………… ………………………………………… …………………………………………………………………………………………………… ………………………………………… From the beginning of which term would you like the grant to commence?...... What are the total costs of your musical activities over the next 12 months?...... How much will you/your parents be contributing to the cost?...... Have you applied elsewhere for financial assistance? If so, please give brief details…………….. …………………………………………………………………………………………………… …………………………………………. …………………………………………………………………………………………………… …………………………………………. If you have previously applied to this Trust for support, please give the date(s) and details of all grants awarded…………………………………………………………………………………………………………………. …………………………………………………………………………………………………… ………………………………………….

Section C - Financial Statement

This section should be completed by your parents or carers unless you do not receive any financial support from them, in which case you need only provide details of your own income (including any student loans)

Patrons: Marin Alsop; Natalie Clein; The Lady Digby DBE DL; Dame Emma Kirkby OBE; Jennifer Pike. Trustees: Christine Dipple; Vicky McDonaugh; Nichola Gunn; Malcolm Lofts; John Nash; Lisa Tregale. Partner A Partner B Total Student Net Monthly Income (Total from all sources after tax and deductions) £…………….. £……………. £……………. £……………

Number of dependants……………….

Are you or your parents/carers in receipt of any state benefits? Please tick as appropriate

Universal Tax Credit (Covers all * Guaranteed Element of State Pension benefits) Credit * Working Tax Credit Support under Part VI of the Immigration and Asylum Act 1999 * Housing Benefit Council Tax Benefit * Employment Support Allowance Disability Living Allowance * Child Tax Credit Carers Allowance * Jobseeker’s Allowance Other (please state)

* Income Support

Is there any reason why your financial circumstances might change significantly during the next twelve months? Yes No

Are there any reasons why this grant application should be treated as a matter of particular urgency ? Yes No

If you have answered Yes to either of the above please give details…………………………….. …………………………………………………………………………………………………… ……………………………….. …………………………………………………………………………………………………… ………………………………… …………………………………………………………………………………………………… …………………………………

Section D - Declaration

Please complete one of the following:-

Patrons: Marin Alsop; Natalie Clein; The Lady Digby DBE DL; Dame Emma Kirkby OBE; Jennifer Pike. Trustees: Christine Dipple; Vicky McDonaugh; Nichola Gunn; Malcolm Lofts; John Nash; Lisa Tregale. If you are a Parent or Carer

I certify that the information given in this application is true and correct to the best of my knowledge and belief. I have read the notes of guidance on Applying for a Grant, and I agree to be bound by the terms and conditions they contain. I attach a teacher’s endorsement in support of the application.

The Trust may wish to use photographic material of young people it supports in its publicity. Such material will not give any information, such as names or addresses, by which the young people could be identified.

I do/do not consent to the use of such material (please delete as appropriate)

Signature……………………………………………………….. Date………………………………… Name (please print)………………………………………………………………………………………………… Relationship to student……………………………………………………………………………………………

If you are aged over 18 and applying to be considered as an independent student

I certify that the information given in this application is true and correct to the best of my knowledge and belief. I further certify that I receive no financial support from my parents/carers. I have read the notes of guidance on Applying for a Grant, and I agree to be bound by the terms and conditions they contain. I attach a teacher’s endorsement in support of the application.

Signature…………………………………………………….... Date…….…………………………

Patrons: Marin Alsop; Natalie Clein; The Lady Digby DBE DL; Dame Emma Kirkby OBE; Jennifer Pike. Trustees: Christine Dipple; Vicky McDonaugh; Nichola Gunn; Malcolm Lofts; John Nash; Lisa Tregale.