The Safety Centre (Milton Keynes)

THE SAFETY CENTRE (HAZARD ALLEY)

BURSARY APPLICATION FORM

The objective of the Bursary is to provide grants to meet all or part of the cost of safety education for children, or groups of children, that are ‘disadvantaged’ in the means of not being able to benefit from the Safety Centre facility.

1. Name of Organisation: …………………………………………………………………...

2. Address: ………………………………………………………………………………….

…………………………………………………………………………………..

……………………………………… Post Code …………………………..

3. Name for contact: …………………………………………………………………………

4. Position: …………………………………………………………………………………..

5. Daytime Telephone No: …………………………………………………………………...

6. (a) Amount requested: ………………………………………………………………...

(b) Total cost of visit: …………………………………………………………………

7. How will the balance (if any) of the whole project be funded? …………………………...

……………………………………………………………………………………………….

8. How many children will benefit ?…………………………………………………………... ……………………………………………………………………………………………….

9. Have you already booked your visit to the Safety Centre? ………………………………..

10. Have you made an application, or intend to apply to any other organisation, for funding the visit? …………………………………………………………………………………..

………………………………………………………………………………………………

11. Any additional information, which may help us, especially regarding the number of children ‘disadvantaged’, socially or financially. ………………………………………...

………………………………………………………………………………………………

SIGNATURE ………………………………………………………………………………..

DATE …………………………………………………………………………………

Please return to The Bursary, c/o The Safety Centre, 18 Carters Lane, Kiln Farm, Milton Keynes. MK11 3ES. Tel: 01908 263009. Fax: 01908 262771 Email: [email protected]

PLEASE NOTE: We are sorry that a grant may not always be approved, as funds are restricted. The Trustees are not obliged to give reasons for refusal and have the absolute authority in all cases.

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(For internal use only)

Amount awarded by the Bursary: £……………………………………………………………

Date: …………………………………………………………………………………………...