Application for an Undergraduate Travel Bursary

Part 1: To be completed by the pupil/student

Last name:

First name:

UCAS Number:
Do you live with a parent?

Yes

No

If No, please specify whether you live with another relative, or if you are in foster care or local authority
care
Current address:

Telephone number:

E-mail address:

Name and address of secondary school or college:

If you attend an independent school/college, please tick the box if you are on an assisted place
Are you, or have you been, in receipt of one of the Governments Education Maintenance Allowances?
Yes

No

If Yes, please specify the amount you received and the dates you were paid:

Please state the title of the course you have applied for together with the course code:

Have you accepted your departmental invitation to interview/open day?

Yes

No

Please include a copy of the invitation letter with this application form when you return it to this office
Please turn over

Part 2: To be completed by the pupil/student travel details

Please indicate your means of transport::
Train

Bus/coach

Other:

Car

Please specify

If travelling by train, bus or coach, please specify your departing station:

Please state the date of travel:

and departure time:

The arrival station will always be taken as Bristol Temple Meads (or Bristol bus station), except in the case of
students attending the School of Veterinary Sciences at Langford, where the nearest station is Yatton.
Please return proof of travel, either a copy of your receipt or your ticket, when you return this form to
the Student Funding Office.
Where receipts (or copies of tickets) are not supplied for train travel, bursaries will be paid in
accordance with the most economical fare available on The Trainline website (www.thetrainline.com).
In the case of bus/coach travel, the fare used for assessment will be based on information on the
National Express website (www.nationalexpress.com) if proof of travel is not supplied.
If travelling by car, then the mileage for a return journey from your home postcode to the universitys
postcode, according to the AA route planner website (www.theaa.com), will be multiplied by 15p per mile to
obtain an overall cost of petrol, and therefore value of bursary.
Costs of taxis will not be reimbursed, except in the case of School of Veterinary Sciences applicants where
10 will be allocated for the return journey from Yatton station to the School as there is no alternative means
of travelling between the two.
Please note that costs of overnight accommodation will also not be reimbursed.

The information I have given on this form is complete and accurate to the best of my knowledge and belief:
Signed:

Date:

Print name:

Please return this form, together with receipts for travel, where available, a copy of your invitation letter from
the university, and page 3 of this form, completed and signed by your parent/guardian, to:
Student Funding Office
University of Bristol
Senate House, Ground Floor
Tyndall Avenue
Clifton
BRISTOL BS8 1TH

Part 3: To be completed by the parent/guardian

What is the gross annual income of you and your partner, if applicable, (i.e. before National Insurance and
tax deductions are made).
Please include any benefits you receive in this figure.
Please note that households with an income in excess of 42,620 are unlikely to be given an award.
Your annual income:

Your partners annual income:

Please specify if you or your partner are currently in receipt of any of the following:
You

Your partner

Income support
Jobseekers Allowance
Working Tax Credit
Child Tax Credit
Disabled Persons Tax Credit
Incapacity Benefit
Severe Disablement Allowance
Industrial Injuries Benefit
Disability Working Allowance
Other
Please specify

Are you in receipt of:

Housing Benefit?

Name and address of administering local authority:

Signature of parent/guardian:
Print name:

Council Tax Benefit?

Both