Confidential Statement of

Financial Circumstances

in support of application for a Grant

    1. CHILD

    2. PARENTS

    Father/Step-father/Partner

    Mother/Step-Mother/Partner

    (a) Names

    (b) Style or Title

    (c) Address(es)

    (d) How long resident in Sheffield area

    (e) Occupation

    (f) Daytime Tel No

    3. INCOME

    (Please enter below your current earnings and expected income from all sources for this tax year commencing 6 April - please estimate annual rate where not known precisely)

    Father (£)

    Mother (£)

    (a) Gross salary and other similar earnings (including all taxable benefits and emoluments)

    (b) Profits of business or profession

    (c) Gross pension, widow's pension etc (occupational and state pensions)

    (d) Gross investment income from dividends, interest, property income etc

    (e) Redundancy or lump sum payments

    (f) Social Security benefits (other than state pension)

    (g) Separation or Maintenance Allowance

    (h) Benefits in kind provided free by reason of employment

    (i) Any other income not included in (a) to (h) above

    NOTE: YOU MAY BE ASKED TO PROVIDE PROOF OF INCOME DERIVED FROM ANY OF THE CATEGORIES LISTED ABOVE INCLUDING WHERE APPROPRIATE P60s, SCHEDULE D OR SCHEDULE E ASSESSMENTS, MONTHLY PAY SLIPS, COMPANY ACCOUNTS ETC.

    4. OUTGOINGS

    (a) Tax payable on Incomes declared above (including tax deducted at source)

    (b) National Insurance Contributions

    (c) Superannuation contributions

    (d) Mortgage payments (annual rate)

    (e) Endowment mortgage insurance

    (f) Any other interest payable (please specify)

    (g) Annual rent and/or Council Tax payable on home

    (h) Water/Electricity/Gas

    (i) General Insurances

    (j) Household expenses (food, laundry etc)

    (k) Clothing

    (l) School Dinners/Childminding

    (m) Car expenses

    5. CAPITAL ASSETS

    (a) Approximate market value of all investments (including stocks, shares, unit trusts, PEPs, Tessas, Bank and Building Society deposits)

    (b) Approximate market value of House (freehold or leasehold)

    (c) Approximate market value of other possessions including house contents, cars etc

    (d) Cash at banks or elsewhere

    (e) Approximate market value of any other assets (please specify and include the market value of any Insurance Policies maturing in this tax year)

    (f) Approximate market value of any other properties owned either at home or abroad

    6. CAPITAL LIABILITIES

    (Please give details of any capital charges against the assets declared in Section 5)

    (a) Mortgage - amount outstanding on house

    (b) Other liabilities

    7. DEPENDENT CHILDREN

    (Include the child to whom this application refers: if more than 4 children, give details on a separate sheet)

    1

    2

    3

    4

    (a) Forename

    (b) Date of Birth

    (c) Sex

    (d) School or College

    (e) Boarding or Day

    £

    £

    £

    £

    (f) Annual school or other educational fees (excluding extras and sundry disbursements)

    (g) Compulsory additional school charges

    (h) Amount of fees shown in (f) covered by:

           (i) Government Assisted Places Scheme, Scholarships, Bursaries or allowances given by school

           (ii) Annual sum arising from capital repayment scheme

           (iii) Services/Company Allowances (gross) (state whether the sum has been included in gross salary at 3(a))

           (iv) Annual sum arising from Educational Insurance Policies

           (v) Assistance from any other sources (eg Grandparents, trusts, settlements etc (please specify)

    (i) Annual income of child (if any)

    The details requested with regard to the fees payable on behalf of your other children are for information only and will not normally be taken into account in the assessment of the level of grant awarded

    8. OTHER DEPENDENTS

    9. ANY OTHER RELEVANT INFORMATION

    ASSISTANCE FROM OTHER SOURCES

    In order to help the greatest number of parents who need financial assistance, or pupils who need financial assistance, all those who apply for a grant are asked first to enquire of the school if they are eligible for assistance from any other source

    Please state:

    (a) whether you have applied to trusts or foundations for a grant?

    (b) if so to which trusts and foundations and with what result?


    Privacy Notice

    Personal Data Provided to the Foundation In Relation To Its Grant Making Activity

    Sheffield Bluecoat & Mount Pleasant Educational Foundation (registered charity No 529351)Derwent House, 150 Arundel Gate, Sheffield, S1 2FN (referred to here as ‘the Foundation’)is committed to protecting the privacy and security of the personal information of individuals in relation to its grant making activity.

    Correspondence arising from this privacy notice or questions concerning it should be directed to the Foundation’s Secretary at the above address.

    Individuals about whom the Foundation might receive and hold personal information may include:-.

    ·          Applicants for grants.

    ·          Recipients of grants.

    ·          Referees named in grant applications.

    ·          Individuals named as being involved in projects or activities for which a grant is being sought, or has been awarded.

    ·          Other individuals who have enquired about, or have an interest in, the Foundation’s grant making activity.

    This privacy notice describes how the Foundation collects and uses personal information about such individuals in order to carry out its grant making activity in accordance with the General Data Protection Regulations (known as ‘the GDPR’). For these purposes the Foundation is a “data controller”. This means that it is responsible for deciding how it holds and uses personal information about the individuals referred to above. It applies to all such individuals, whether their involvement is current or in the past.

     

    How is personal information about individuals collected?

    The Foundation typically collects personal information about individuals in the following ways:-

    • Receipt of grant application forms, accompanying correspondence and supporting documentation.
    • Obtaining references for grant applications.
    • Correspondence or discussions relating to grant applications as they are being processed and considered.
    • Correspondence or discussions relating to successful applications, including payment arrangements.
    • Obtaining reports and feedback about outcomes arising from the Foundation’s grant making activity.
    • Enquiries about potential grant applications, expressions of interest and those known to the Foundation as being interested in its grant making activity.
    • Receiving grant applications that have been submitted to other grant making charities, which have been lawfully passed on to the Foundation to consider.

     

    Personal information about individuals other than the provider of the information

    In relation to personal dataabout other individuals which is provided to the Foundation, it is vital that anyone providing such information ensures that they themselves comply with data protection law (including the GDPR) and ensure the accuracy, quality and legality of such personal information and the means by which it has been acquired and provided.

    The provider must also establish the legal basis for processing any individual’s personal information under such data protection law, including by providing all notices and obtaining all consents as may be required in order for the Foundation to process such personal information for the purpose of its grant making activity.

    Anyone considering providing such information to the Foundation may wish to first provide any other individuals with a copy of this privacy notice for them to consider and to obtain express consent to providing the Foundation with any sensitive personal data (see below).

     

    How the Foundation uses information about individuals

    The Foundation will only use personal information about individuals as the law permits. Most commonly, this will be for the following lawful reasons:

    1. In order for the Foundation to undertake its grant making activity, including steps taken prior to, and after, the consideration of the making of grants.[*]

    2. Where the Foundation needs to comply with a legal obligation.[**]

    3. Where it is necessary for the Foundation’s legitimate interests (or those of a third party) and the interests and fundamental rights of the individual do not override those interests.[***]

    4. Where the Foundation has obtained the individual’s freely given, specific, informed and unambiguous consent by way of a statement or clear affirmative action.[****]

    The Foundation will use personal information about individuals for the purposes of its grant making activity, usually in the following ways (the asterisk next to an activity below corresponds to the asterisk next to a lawful reason above, to demonstrate the lawful reason the Foundation relies on to undertake that activity):

    ·                To correspond with applicants in order to process and consider grant applications.*

    ·                To obtain references.***

    ·                To communicate the outcomes of grants applications.*

    ·                To correspond with recipients of grants in order to administer those grants and facilitate payments.*

    ·                To liaise with recipients of grants to obtain reports and feedback about outcomes arising from its grant making activity.***

    ·                To correspond with recipients of grants if it is felt that their project or activity may be used as a case study for good practice or other promotional purposes***.  The Foundation would not share details without seeking prior permission.

    ·                To maintain a central database of information relating to applications received and grants made by the Foundation, and to record their outcomes.***

    ·                To contact individuals or organisations that may be eligible for a grant who are known to the Foundation and have enquired about, or expressed an interested in, the Foundation’s grant making activity.***

    ·                To inform individuals or organisations of events/ meetings that may be of interest to them, in relation to their projects/activities.***

    ·                The Foundation may disclose grant applications and information otherwise provided, in whole or part, to selected other charities which may be able to consider providing grant support***. If individuals do not want such information being disclosed this should be indicated by ticking the appropriate box at the end of this privacy notice or by contacting the Foundation’s Law Clerk/Clerk/Secretary.

    ·                To comply with the Foundation’s legal, accounting and reporting obligations to the Charity Commission and other regulatory and statutory bodies.**

    ·                To share information as necessary with the Foundation’s professional advisers, including its lawyers and accountants.***

    To retain documentation in relation to its grant making activity and other paperwork in order to deal with future requests, queries or complaints, in relation to which the Foundation and its professional advisers may also use third party storage and information back-up services which may have access to personal data***.However they are not permitted to process any such data other than on the Foundation’s behalf and at all times personal data will remain confidential.

    The Foundation may also use personal information about individuals in the following situations, which are likely to be rare:

    ·                Where the Foundation needs to protect the individual’s vital interests (or someone else’s vital interests).

    ·                Where it is needed in the public interest.

    The Foundation may include information about its grant making within its Trustees Annual Report and Financial Statements, as submitted to the Charity Commission and made available on the Commission’s website as a matter of public record. Ordinarily this would be a list of grants made and recipients. The Foundation may also choose to otherwise publish such information or share it with others. When doing so the Foundation will not include the personal data of any individuals without their prior consent (which would be additional to the consent provided for under this Privacy Notice).

    Consent to the Foundation using sensitive personal data

    To the extent that information provided to the Foundation (see How is personal information about individuals collected?) concerns an individual’s racial or ethnic origin, political opinions, religious or philosophical beliefs, health, sex life or sexual orientation (defined in the GDPR as ‘special categories’ of ‘sensitive personal data’), it is necessary for the Foundation to have express consent, or another lawful reason, to be able to hold and use that information.

    Therefore, if information provided to the Foundation contains such ‘sensitive personal data,’ it is vital that express consent to use that information as set out in this privacy notice is provided and evidenced by the signing and submission of a copy of this privacy notice to the Foundation.

    If a signed version of this privacy notice is not received by the Foundation’s Secretary within three months of a request to do so the Foundation may not be able to continue to hold any such information, may not be able to give it further consideration and may arrange for it to be securely destroyed.

    Change of purpose

    The Foundation will only use personal information about individuals for the purposes for which it is collected, unless it is reasonably considered necessary to use it for another reason and that reason is compatible with the original purpose. If the Foundation needs to use the personal information of individuals for an unrelated purpose, it will tell them about the legal basis which permits it to do so.

    Please note that the Foundation may process personal information about individuals without their knowledge or consent where this is required or permitted by law.

    Retention of personal data and Individuals’ rights

    All personal data, including any sensitive personal data, received and utilised for the purpose of the Foundation’s grant making activity will be destroyed after the Foundation has ceased actively using it for a period ofseven years.

    Individuals are entitled to object to all or any processing of their personal data and/or request that their personal data be erased, at any time, by providing not less than five working days’ notice to the Foundation. Individuals may also withdraw their consent to the processing of any sensitive personal data at any time, although any withdrawal of consent may mean that the Foundation may not be able to adequately consider grant applications or make further payments of already authorised grants.

    Individuals may also request a copy of their personal data that is held by the Foundation (commonly known as a “data subject access request”) and may request the correction of any personal data held about them

    Individuals have the right to make a complaint about the Foundation’s processing of their personal data at any time to the Information Commissioner’s Office (ICO), the UK supervisory authority for data protection issues.

    Your signature on and submission of this form are your confirmation that all of the information provided by you to the Foundation in relation to its grant making activity is correct, complete, true and accurate in all respects.

    Your signature on and submission of this form also confirms that you have read and acknowledge this form and your consent to the Foundation using any sensitive personal data pertaining to you and other individuals in accordance with this privacy notice. You confirm that you have as far as is necessary complied with the requirements under the heading ‘Personal information about individuals other than the provider of the information’set out above.

    Signed:      ………………………………………………………………………………………              Date: …………………………………………………………….

    Print name:   ………………………………………………………………………………………………………………………………………………………………

    The Foundation may disclose grant applications and information otherwise provided, in whole or part, to selected other charities who may be able to consider providing grant support. If you do not agree to such information being disclosed please tick the following box

    ………………………………………………………………………………………………

    Where personal data is provided in relation to a person under 16 years of age, consent must also be provided by their parent or legal guardian.

    Signed:      ………………………………………………………………………………………              Date: …………………………………………………………….

    Print name of parent or guardian:   …………………………………………………………………………………………………………………………

    Relationship ……………………………………………………………………………………………………