LIEF Application Form

First name

Last name

Phone

Birthday

Day

Month

Year

Place Of Birth

Address

Parent's Address

School Attended

Leaving Date

Day

Month

Year

Name the course and qualification for which you want financial help from the trustees

Which University or HE establishment?

Course Start Date

Course Finish Date

Have you been offered a place on the course already?

Please give details of any funding you have already received

Please give reasons for seeking financial assistance from LIEF

Have you previously received a grant from us?

If yes, how much?

Any other information you feel the Trustees should be aware of:

Please attach a reference from your course tutor:

In order for us to successfully process the grant payment, we require the following information:

Bank Sort Code

Bank Account Number

Bank Account Name

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I confirm that the information included in this application is correct and that I have not knowingly omitted any important details.