Henry Cumming Fund Application 2018-2019

Grant Application Form
Henry Cumming Fund Application
Don't forget to update the auto number in the field below based on where previous term numbers end before setting the form to active !
Please don't forget to click on the Submit button at the bottom of this form to complete your application. You will receive an email confirmation on submission.

All sections with a red asterisk * are required.

Please note that priority will be given to those who wish to attend The Anna Fiorentini Theatre and Film School.
TERM: November2018
Is this the first time you have applied to the Fiorentini Foundation? *

Yes No
Child(ren) Details

Please complete the information for each child for whom you are requesting a scholarship: *

	Child's first name	Child's surname	Child's date of birth dd/mm/yy	Age	Male/Female	Name of Primary/ Secondary School

Is your child in the care of the Local Authority, the subject of a care order or in Foster care?

Yes No
Parent / Guardian Details

The person who has parental responsibility for the child, and who the child lives with should complete this section.
Title
Full Name *

First Name Last Name

Address (NOTE: all fields must be completed - "County" can just be London repeated) *

Street Address
Address Line 2
City	County
Post Code	Country

You must provide at least one phone number or email address for us to contact you:
Home Phone Number
Mobile Number
E-mail
Your relationship to the child or children you are applying for

Mother Father Stepmother Stepfather Grandmother Grandfather Guardian Foster parent
Your employment status *

Full-time Part-time Student Unemployed
Your Partner
By your partner, we mean the person who lives with you, e.g. husband, wife, civil partner, boyfriend, girlfriend.

Not Applicable
Title
Full Name

First Name Last Name
Mobile Number
E-mail
Your partner's relationship to the child or children you are applying for

Mother Father Stepmother Stepfather Grandmother Grandfather Guardian Foster parent
Your partner's employment status

Full-time Part-time Student Unemployed
More Information

The Henry Cumming Fund is in place to support children who are suffering or affected by cancer. By offering scholarship places to children in this situatioon we hope to be able to offer respite to the child and their family.
Please let us know about your family and why this scholarship would be of interest to you. *
We understand this is a very sensitive situation, however to ensure the funds are allocated fairly, we would ask that you upload any documents to evidence your case. Please note, these will be dealt with as completley confidential.
If you aren't able to upload a file now, you can scan or take a photo with your phone later and email it to hello@annafiorentini.com (make sure you send photos at full resolution so they are legible). Your confirmation email will have an Application reference ID, please include this with any evidence submitted separately.
Does your child receive funding from any other organisation/ charity to attend extra-curricular activities?

Yes No
If you answered yes, please let us know about the funding you receive and the activity they attend.
Funding Requested
If we are unable to grant a full scholarship, would you be interested in receiving a partial scholarship? *

Yes No
How much per month would you be able to contribute towards fees? *
This will consist of 4 monthly payments per term.
Your Agreement

(Please don't forget to click on the Submit button below to complete your application.)
You must complete this section for us to be able to look at your application. *

I have read the application and attest that the information provided is accurate and truthful to the best of my knowledge. I agree that the Fiorentini Foundation & the Anna Fiorentini Theatre & Film School may exchange information about my application and my child as necessary.
Name of Parent/Guardian *
Date *
Fiorentini Foundation
Registered in England- Company Registration no. 07456832 • Registered charity no. 1140414
Registered office: Unit G34A, Waterfront Studios, 1 Dock Road, London E16 1AH

Find us at www.fiorentinifoundation.org

The Anna Fiorentini Theatre & Film School has procedures in place to keep your personal information secure, including technical security measures. Within our organisation, data is only shared on a need to know basis. We don’t keep any personal data for any longer than required by law and needed for operational purposes, for example to be able to collect outstanding fees.
Should be Empty:

Grant Application Form

Henry Cumming Fund Application

Child(ren) Details

Parent / Guardian Details

Your Partner

More Information

Funding Requested

Your Agreement