Name *

First Name

Last Name

Date of Birth *

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DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Name of Parent/Guardian

First Name

Last Name

Parent/Guardian Phone Number

Parent/Guardian phone number

Country

(###)

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Parent/Guardian Consent *

By ticking the box below, I give consent for my child to apply for the bursary and participate in this project.

Parent/Guardian Consent

Address of School/College *

Address 1

Address 2

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Teacher's Name *

First Name

Last Name

Teacher's Phone Number

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(###)

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Agree to GDPR and T&C *

GDPR Please confirm that you understand that the Society will handle your application details in compliance with GDPR and that all personal data will be kept confidential.

• I consent to the use of my data for the purposes of this bursary application.
• I consent to my work being published and shared with the wider community (if selected as the bursary winner).

T&C

• By submitting your application, you confirm that you understand and agree to the following:
• The research project should be submitted by 10th January 2025.
• You agree to share the copyright of your work with the Histon and Impington Village Society, allowing it to be published and shared with the wider community.
• You will be named in any publications or presentations related to your work.

I agree to the GDPR and T&C