McTimoney McTimoney Trust Student Awards 2015 Application Form Step 1 of 8 12% Part APlease note: the Awards Panel will not see the information given in Part A of this formName* First Last Address* Street Address Address Line 2 City State / Province / Region Postcode AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneEmail Terms and conditions I agree that: All the information I have given on the form is correct and I will let the Trust know if my circumstances change before the Award is given. I undertake to repay, on demand, any overpayments of my Award that may arise due to any false information I have given, miscalculation, re-evaluation of eligibility, or for any other reasonable cause. I give permission for the McTimoney Trust to contact the McTimoney College of Chiropractic to verify information submitted with this application. I understand that, if I am assessed as being eligible for more than one Award, I will receive Confirm that you have read and agree to the above terms and conditions*YesNoI would like confirmation of receipt of my application*NoYes, by emailYes, by postData protection The personal information you have supplied is protected under the 1998 Data Protection Act and will: Be used only in the processing of this Application. Not be disclosed to a third party except where expressly stated in this Form, or in the prevention of fraud, or where the Trust is legally required to share information to Government agencies. Be destroyed in a confidential manner after seven years. save and continue Equalities monitoring The Trust is committed to social justice and equality. We also aim to meet the needs of a wide range of beneficiaries who need the Trust’s support. We work within the Equality Act 2010 and have an Equality and Diversity Policy. We hope you will help us check that we are meeting our aims. We will use the information to check to see if we are providing equality of opportunity. However, you do not have to provide this information if you do not wish to. The information you provide here will not be seen by the people undertaking the assessment of the Awards.AgeMy current age is:Please enter a number from 1 to 99.GenderMaleFemaleDisabilityI have the following disabilities which limit my everyday activity:NationalityPlease state which country you normally reside in (for UK, please state England, Northern Ireland, Scotland or Wales):RaceI would describe my race as being, e.g. White / Asian / Black / Afro-Caribbean / Other / Prefer not to say:Religion or cultural beliefsI would describe my religion or cultural beliefs as, e.g. Christian / Muslim / Jewish / Sikh / no religion / prefer not to say:Sexual orientationI would describe myself as Heterosexual / Homosexual / Gay / Lesbian / Bisexual / Prefer not to say: save and continue How did you hear about the Awards?Please tell us how you heard about the Student Awards - you can select more than one option. Trust e-newsletter College information sessions Posters in College Trust website MCA e-newsletter College staff College website College prospectus College email Chiropractic Matters Fellow student Have applied before BPP University website Other Please state how you heard about the Student Awards save and continue Part BIMPORTANT: All applicants must complete Sections 1 & 2 and provide details for at least one Award on the following pages1 Eligibility criteria - all applicants1.1 Can you demonstrate unplanned financial need?*YesYou need to select this option to be eligible for a Student Award. If you are uncertain whether you are eligible, then save the form as a draft and contact the Student Awards Administrator or phone 07804 1052171.2 Where are you studying?*AbingdonManchester1.3 Which course are you attending?*You need to select one of the 3 options to be eligible for a Student Award. If you are uncertain whether you are eligible, then save the form as a draft and contact the Student Awards Administrator or phone 07804 105217MChiro Full Time (4 years) courseMChiro Part Time (5 years) courseMSc Animal Manipulation (2 years) you are only eligible to apply for the Tony Gilmore Award1.4 Which year of study are you in?*Year 1Year 2Year 3Year 4Year 51.5 What are your start/finish course dates?Start Month*Enter the two digit month that you started the course010203040506070809101112Start Year*Enter the two digit year that you started the course09101112131415Finish Month*Enter the two digit month that you expect to finish the course010203040506070809101112Finish Year*Enter the two digit year that you expect to finish the course15161718192021222324251.6 Which Awards are you applying for?*Tick at least one box if applying. You can apply for more than one Award John McTimoney For exceptional academic achievement Daphne and Norman Tomlin For educating/teaching skills Bronwen Herbertson For determination and practical skills Tony Gilmore For animal health Discretionary For unplanned financial need only 1.7 Have you received funding from the Trust before?*YesNoIf yes, please give details* save and continue 2 Financial need - all applicantsFOR ALL AWARDS: You need to demonstrate unplanned financial need2.1 Are you applying for an Award to fund fees in this academic year or the next academic year?*This academic yearNext academic year2.2 Your original Plan:*Please set out how you intended to fund the academic year you are applying for. Please give expected sources and approximate annual amounts, e.g. savings £2,000, Professional and Career Development Loan £3,000. (Maximum 300 words)2.3 What changed (income)?*Please state briefly in what way your INCOME has changed since you made this Plan. Provide detail where possible (examples: redundancy notice; benefit changes; reduction in working hours/pay, summary tax returns). (Maximum 300 words)2.4 What changed (expenditure)?*Please state briefly in what way your EXPENDITURE has changed since you made this Plan. Provide detail where possible (examples: increase in housing costs; changes in childcare needs). (Maximum 300 words)2.5 Have you sought any financial advice*YesNoPlease explain:* (Maximum 100 words) 2.6 Total mileage costsHow many miles do you have to travel to get to the College during the academic year?*Please enter a number less than or equal to 99999.@ 45p per mile* save and continue 3 Current Annual Income & Expenditure SummaryPlease provide a summary of your annual current income and expenditureINCOMEYour income sourcesAnnual Salary/WagesPlease enter a number less than or equal to 999999.Annual Salary/Wages DetailsPlease give brief detailsAnnual Interest/dividendsInterest/dividends detailsPlease give brief detailsAnnual Student-related loans/grantsStudent-related loans/grants detailsPlease give brief detailsBenefitsBenefits detailsPlease give brief detailsOtherPlease state your other income sourcesTotal incomeTotal savings including sharesPlease enter a number less than or equal to 9999999.00.Your partner's income sourcesPartner's Annual Salary/wagesPlease enter a number less than or equal to 999999.Partner's annual Salary/wages detailsPlease give brief detailsPartner's Interest/dividendsPartner's Interest/dividends DetailsPlease give brief detailsPartner's Student-related loans/grantsPartner's Student-related loans/grants detailsPlease give brief detailsPartner's BenefitsPartner's Benefits detailsPlease give brief detailsPartner's Other incomePlease state partner's other income sourcesTotal Partner incomePartner's Total savings including sharesPlease enter a number less than or equal to 9999999.00.JOINT TOTAL INCOMEJOINT SAVINGSHOUSEHOLD SIZENo. of adults (18 years plus), including dependent adults, you and your partnerPlease enter a number less than or equal to 99.No. of dependent childrenPlease enter a number less than or equal to 99.Household Size TotalYou are welcome (but not required) to provide any comments to explain your household circumstances in the ‘Any additional comments’ box at the end of Section 3.EXPENDITUREMcTimoney College of Chiropractic course feesPlease enter a number less than or equal to 999999.Other educational related feesPlease enter a number less than or equal to 999999.Loan repaymentsMortgage repayments on main homePlease enter a number less than or equal to 999999.Mortgage repayments on other propertiesPlease enter a number less than or equal to 999999.Mortgage repayments on other properties: detailsRepayments on student related loansPlease enter a number less than or equal to 999999.Repayment on other loans and HP AgreementsPlease enter a number less than or equal to 999999.Repayment on other loans and HP Agreements: detailsRepayments on credit cards and overdraftsPlease enter a number less than or equal to 999999.Other RepaymentsPlease enter a number less than or equal to 999999.Please state other repaymentsHousing costsRent / Ground rent / Service charges main homePlease enter a number less than or equal to 999999.Rent / Ground rent / Service charges other homePlease enter a number less than or equal to 999999.Housing related insurance costsPlease enter a number less than or equal to 999999.Council Tax: main homePlease enter a number less than or equal to 999999.Council Tax: other homePlease enter a number less than or equal to 999999.Electric / Gas / Fuel / WaterPlease enter a number less than or equal to 999999.Telephone / Broadband (landline and mobile)Please enter a number less than or equal to 999999.TV licence / SubscriptionsPlease enter a number less than or equal to 999999.Other housing costsPlease enter a number less than or equal to 999999.Please state other housing costsOther essential costsChildcare costsPlease enter a number less than or equal to 999999.School fees for (dependants)Please enter a number less than or equal to 999999.Insurance / Endowment premiumsPlease enter a number less than or equal to 999999.Membership of professional bodiesPlease enter a number less than or equal to 999999.Other essential costsPlease enter a number less than or equal to 999999.Please state other essential costsTotal mileage costsTOTAL ANNUAL EXPENDITUREIf you feel you need to explain or give any additional information please do so here. (Maximum 100 words)Total household income less expenditureTOTAL HOUSEHOLD INCOME LESS EXPENDITURE PER PERSONANY ADDITIONAL INFORMATIONPlease use this space if you want to add any additional comments about your income, expenditure or household circumstances (Maximum 100 words) save and continue 4 Student AwardsYou can apply for as many Awards as you wish, but please make clear which ones you are applying for by answering the first question with either ‘Yes’ or ‘No’ in each of the Award sections4.1 The John McTimoney Bursary Award: for exceptional academic achievement - 4 Awards available £3,000 awarded to students on the Integrated Undergraduate Masters in Chiropractic Programme (any Year) Criteria Unplanned financial need Demonstrate exceptional academic achievement (Module Scores averaging at least 70%) I wish to be considered for John McTimoney Bursary AwardYesNoYou will need to provide evidence of: Transcript of Module Marks (available from the Course Manager at the College) Letter of support from a senior member of staff at the College, e.g. Principal, Vice Principal, a Director or Head of Year Evidence of extenuating circumstances if your pass rate is 60% to 69% - can be included in above evidence John McTimoney Bursary Award informationPlease use this space to add any information you would like to provide in support of your application (Maximum 300 words)4.2 The Daphne & Norman Tomlin Bursary Award: to encourage use of educational skills - 2 Awards available £2,000 awarded to students on the Integrated Undergraduate Masters in Chiropractic Programme (any Year) Criteria Unplanned financial need Demonstrate existing teaching/educational skills and experience I wish to be considered for Daphne & Norman Tomlin Bursary AwardYesNoYou will need to provide evidence of: The range and quality of your educating skills (e.g. feedback from students, supervisor/ manager, certificates/qualifications) Daphne & Norman Tomlin Bursary Award informationBriefly describe your teaching/educational skills and how you might want to use them currently or in the future to promote the McTimoney approach to Chiropractic (Maximum 300 words) 4.3 The Bronwen Herbertson Bursary Award: for determination and practical skills - 2 Awards available £2,000 awarded to students in their final two years of the Integrated Undergraduate Masters in Chiropractic Programme Criteria Unplanned financial need Exceptional McTimoney techniques and practical skills Have successfully overcome personal obstacles to train as a McTimoney Chiropractor I wish to be considered for Brownwen Herbertson Bursary AwardYesNoYou will need to provide evidence of: Transcript of Module Marks (available from the Course Manager at the College) Letter of support from Director of Clinic Brownwen Herbertson Bursary Award informationDescribe how you have successfully overcome personal obstacles to train as a McTimoney Chiropractor (Maximum 500 words) 4.4 The Tony Gilmore Bursary Award: for animal health - 2 Awards available £1,000 awarded to a student enrolled in Years 1 or 2 of the MSc Animal Manipulation Course Criteria Unplanned financial need Be enrolled on the MSc Animal Manipulation Course Hold a human Chiropractic qualification awarded by the McTimoney College of Chiropractic Be a member of the McTimoney Chiropractic Association I wish to be considered for Tony Gilmore Bursary AwardYesNoYou will need to provide evidence of: Enrolment on the MSc Animal Manipulation Course Your human Chiropractic certificate awarded by the McTimoney College of Chiropractic Tony Gilmore Bursary Award informationPlease use this space to add any information you would like to provide in support of your application (Maximum 300 words) 4.5 Discretionary Award: to assist with unavoidable financial need - at least 12 Awards available Maximum of £1,000 for students on the Integrated Undergraduate Masters in Chiropractic Programme Criteria Unplanned financial need I wish to be considered for Discretionary AwardYesNoYou will need to provide evidence of: Evidence of being currently enrolled on the MChiro programme Discretionary Award informationPlease provide additional commentary as to why you should be considered for this Award (Maximum 500 words) 4.6 Additional information - all AwardsPlease provide additional information as to why you should be considered for any of these Awards (Maximum 500 words) save and continue 5 Evidence checklistPlease confirm what evidence you are providing to support your application. You can scan and upload your evidence at the end of the form or photocopy and post it.Income Evidence Bank statements P60 HMRC (tax) returns Summary Page of Loan Agreements Wage slips Benefit evidence Other Other Income Evidence ExplanationPlease state other income evidence you are providingEXPENDITUREExpenditure Evidence Change in housing costs Other Other Expenditure Evidence ExplanationPlease state other expenditure evidence you are providingJOHN MCTIMONEY BURSARY AWARDJOHN MCTIMONEY BURSARY AWARD Evidence Transcript of Module Marks (available from the Course Manager at the College) Evidence of extenuating circumstances if marks 60-69% Letter of Support from a senior member of staff at the College, eg Principal, Vice Principal, a Director or a Head of Year DAPHNE & NORMAN TOMLIN BURSARY AWARDDAPHNE & NORMAN TOMLIN BURSARY AWARD Evidence Evidence of the range and quality of your educating/teaching skills BRONWEN HERBERTSON BURSARY AWARDBRONWEN HERBERTSON BURSARY AWARD Evidence Transcript of Module Marks (available from the Course Manager at the College) Letter of Support from Director of Clinic TONY GILMORE BURSARY FOR ANIMAL HEALTHTONY GILMORE BURSARY FOR ANIMAL HEALTH Evidence Your human Chiropractic certificate awarded by McTimoney College of Chiropractic Evidence of Enrolment on MSc Animal Manipulation Course DISCRETIONARY AWARD AWARDDISCRETIONARY AWARD Evidence Evidence of being currently enrolled on the MChiro programme Evidence SubmissionI am sending my evidence documentation:ElectronicallyBy postBoth electronically and by postBank statementsP60HMRC (tax) returnsSummary Page of Loan AgreementsWage slipsBenefit evidenceOther Income Evidence Files Drop files here or Change in housing costsOther Expenditure Evidence Files Drop files here or Transcript of Module MarksEvidence of extenuating circumstances if marks 60-69%Letter of Support from a senior member of staff at the College, eg Principal, Vice Principal, a Director or a Head of YearEvidence of the range and quality of your educating/teaching skillsLetter of Support from Director of ClinicYour human Chiropractic certificate awarded by McTimoney College of ChiropracticEvidence of Enrolment on MSc Animal Manipulation CourseEvidence of being currently enrolled on the MChiro programme save and continue This iframe contains the logic required to handle Ajax powered Gravity Forms.