Section A *

Please confirm that you meet the following criteria (only students meeting ALL the criteria in this section need apply).

By ticking this box I confirm that I will be aged 18+ by or on 30th June 2024.

I attend one of the following schools as a Year 14 A level student: Ballymena Academy, Cambridge House, Cullybackey College, Dunclug College, Saint Louis Grammar, Saint Patricks College, Slemish College.

I live permanently at an address in BT42 or BT43. (Some addresses in BT44 will be considered).

My predicted grades are (minimum) three ‘B’s

I intend to study at either Ulster University or Queens University commencing September/October 20234

I am not intending to study a health or physical fitness related degree

Section B *

Please confirm that you meet at least one of the following criteria (select all that apply)

My parent(s) are in receipt of Universal Credit

I live in social housing (NIHE or Housing Association tenant) or in a recognised social housing area

I live in a household with a single parent/guardian

Combined household income under £40,000.00 per annum

I am not living with or supported by my parent(s)

Your name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Confirmation *

By submitting this form, I confirm that all information given is accurate and I understand that submission of this form does not constitute an offer of financial support from the Gallaher Trust or Supporting Communities.

If my application is progressed to the next stage, I will consent to attend an interview.

If successful at interview, I consent to take part in all fund related / Supporting Communities publications, related to the Scholarship, for marketing/advertising purposes.