Education Support Fund Form

ELI Educational Scholarship Fund 2018

Please complete all sections of the form. ELI will not contact applicants who do not provide all information requested.

Child's Name

Parent's Name

Address

Home Phone

Mobile

Child's Date of Birth

How long have you lived in the Docklands Area

Primary School

Date Enrolled

Secondary School (if applicable)

Date Enrolled (if applicable)

Any previous involvement with ELI/NCI programmes (This is not a requirement for funding)

Yes
No

Funding Category - please select one option

Educational Equipment
Educational Assessment/Support
Extra-curricular educational course/activity

Please provide details

Amount applied for (Guideline €200-€1000)

€

How would the Scholarship Fund benefit your education (Max 100 words)

First Name & Surname

Email Address

Contact Number

Role (please select one option)

*This application can be completed by the applicant depending on their age

Applicant*
Parent/Guardian
Teacher/Educator