Thomas Wall Trust - Review Application

Click 'Amend' to return to your form and make any changes.

You can review your answers to the form questions here. If you are happy with your application, click 'Submit' to send it to us.

Once you have clicked the Submit button you will not be able to make any further amendments to your application.

Applicant Name

*Name
(Title, first name, last name)

Address

*Address1:

Address2:

Address3:

*Town:

County:

*Postcode:

Country:

*Region

Please select individual

*Email:
(This email address will be used to send you an acknowledgement and a copy of your application form when you have finished your application.)

*Telephone

*Date of Birth

*Age

*Gender

*Ethnicity

A10

If you are not a UK citizen, where is your place of birth and how long have you lived in the UK?

A11

Employment history, starting with your current/most recent job

From/To	Employer's name	Job title	Salary

A12

*Marital status

A13

*With whom do you normally live with?

A14

Please tell us about your previous education and qualifications obtained

From/To	School/College/University	Subjects studied, level (e.g. diploma) and result

A15

If you left school with little or no qualifications, please tell us why

*Have you been unemployed for 6 months or more within the last two years?

*We shortlist applicants that most meet the Trust's aim of helping people who want to break through the barriers in their lives and finding paid work.
Please can you tell us why you have been unemployed, and how your circumstances fit this description?

Your total household weekly income

If 'other' please detail in B8

For any field that doesn't apply to you please enter zero.

Income	Amount per week (£)
Wages/Salary
Housing Benefit
Working and Child Tax Credits
Job Seekers Allowance
Pension Credit
Disability Living Allowance (DLA)
Carers Allowance
Income Support
Employment and Support Allowance (ESA)
Personal Independence Payment (PIP)
Child Benefit
Universal Credit
Other (please detail below)

*Your annual household income after tax (£):

*Whilst studying or working would you need to arrange childcare?

*Do you have any carer responsibilities?

*Do you have a disability?

If you have answered YES to any of the questions in this section please tell us more

*Course title

*Level of qualification

Course cost (£)

*What are you applying for?

Please note: maintenance includes costs such as travel and childcare

If you are applying for additional costs aside from course fees, please detail

If this isn't a one off cost please provide a breakdown and total.

*Total amount requested (£)

If this exceeds £1,500 please tell us how you plan to make up the shortfall

Please tell us which other charities or funds you have applied to and for how much

*Is your course eligible for an Advanced Learner Loan?

C10

*Course provider's name & location

C11

*Course start date

C12

*Course length

C13

*Course completion date

If unsure, please estimate

C14

*Have you already started this course?

C15

*What jobs could this course lead to? Please tell us about the research you have done in relation to this

*Referee name

*Your Referees email

*How do you know this person?

*How did you hear about us?

I declare that the above information is correct and complete to the best of my knowledge.
I consent to the Trust holding personal data on its secure website and database for assessment and monitoring purposes (your application cannot be processed without you agreeing to this).
I agree to update the Trust on any changes in my circumstances.