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Bursary Application Form

Parent/Guardian’s Contact Details (if applicable) - Name:
Email Address
Telephone Number
Personal details: Please provide the applications personal details - Name
Fireann / Baineann :

Male / Female
Address
Post Code
Date of Birth
School details (if applicable) Please give the details of your school and the name of your Class Teacher.
Course details: Please give details of the course for which you are seeking a Mid Ulster District Council Regional & Minority Languages Grant. (Course name, address, dates, cost and contact details for the course administrator).
Course Benefits: Please describe how the course will help develop your language skills.
I am resident in the Mid Ulster District Council area
I am registered to attend a course to improve my regional minority language skills
I do not have a scholarship from public funds to attend the course (eg DfC LÍOFA Bursary)
I intend to complete the course by staying for its full duration and will provide proof of full attendance and payment of course fees
Declaration: I confirm that the information I have provided is true and accurate to the best of my knowledge. Applicant's Signature:
Date
Parent’s/Guardian’s Signature (if applicable)

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