Bursary Application Form: Care Leavers, Young Carers and Estranged Students

Before completing this form, please ensure that you meet the eligibility criteria and have read the terms and conditions of the bursary, which are available on our website: www.aber.ac.uk/careleavers.

If you need any assistance completing the form, please phone us on: 01970 628786

Section A: Personal Details

UCAS Personal ID

Surname

Forename(s)

Preferred name

Date of birth (DD/MM/YYYY)

Email Address

Telephone Number

Term-Time Address (if known) including post code

Preferred language of communication

Department/Course applied to at Aberystwyth University

If available, please provide the name and contact details of your Keyworker, Social Worker, Teacher, Doctor or most relevant person within your Local Authority to contact to verify your circumstances:

Name

Job Title

Contact Address

Telephone Number

Section B: Category of Award

I am applying for this award as a (please select appropriate choice):

Supporting evidence must be provided (see Section C).