THE ROBERT BOUFFLER MUSIC TRUST

APPLICATION FORM – Private and confidential
Please read the notes at the foot of page two before completing this form.

Name: 

Age:	

Address: 

E-mail address:
					
Tel. No. 						Mobile:
									
School:						Tel. No. 
				
Head of Music:					Tel. No.:
		
Instruments studied:		Grade:		Teacher:		Tel. No.:

1. 							

2.

3.

Orchestras and Music Groups:  Surrey Arts East

Competitions and awards, etc.: Academic qualifications and present academic studies:

Proposed further study and ambitions:

Other interests: 

										[ continued overleaf ]

[ page two ]

Purpose of your application to the Trust: 

Financial details relevant to your application (use a separate sheet if needed):

NB Please include the cost of lessons if you are applying for assistance with these; if for help 
with the purchase of an instrument then the approximate cost of that instrument and, if possible, the vendor.

Have you applied to any other organisation?  If so, please give details and indicate if any financial assistance is promised.

Parents’ occupations, number and age of siblings and any applicable family circumstances:

Our Deed of Trust states that the Trustees should give preference "to those of limited means who would otherwise find difficulty in studying and appreciating music”.  The more information you can provide, particularly on the financial side, the easier it is for the Trust to assess your application.
Our Deed of Trust also states that beneficiaries must be resident or attending school in the Borough of Reigate & Banstead or the District of Tandridge.  Please let us know of any move or change of school.

This form will be used by the Trustees only and all information will be treated
in confidence.