If you wish to make an application for a bursary from the Harry Guntrip  Psychotherapy Trust please fill out the form below. Fields marked with * are required.

All information is confidential and will only be used for your bursary application. It will not be passed on to any 3rd party.

Please could you confirm by September 20th that you have taken up a place on your course . If we do not hear from you we will assume that you have not taken up your place and your application for a bursary will not be considered.

Contact Details

Name *

Address *

Postcode *

Email *

Confirm Email *

Employment

Are you:

If Other please specify

Where are you working?

Course Details

Course Title

Year Started

Course Fees

Therapy Fees

Subsistence

Amount of Financial Support from Other Sources

Are you currently receiving any financial support?

YesNo

If YES, please state how much and who from

Are you applying for financial support to other organizations besides the Harry Guntrip Psychotherapy Trust?

YesNo

Other relevant financial support