Bursary application form

adventures in intimacy

Bursary Application

First Name:

Last Name:

Email:

Phone:

Have you had assistance from the Bursary Fund in the past?

Yes

No

If so, please say when and how much:

Which event are you hoping to attend?:

How much help would you like from the Bursary Fund?:

What is the minimum contribution you need to attend?:

In the last year, approximately how much income did you receive?:

What are your regular monthly outgoings (rent, mortgage, bills, food etc)?:

Please give details of any medical or disability issues:

Is there anything else we should take into account when considering your application?:

This field must be left blank