Catalyst Summit Bursary Application Form
To apply for a free sponsored bursary to attend our 2021 Catalyst Summit learning and mentoring programme. It is for teenage girls & young women aged 16-24 years. For all queries contact Traci Lewis  traci@catalysechange.com  M 07870 268 654 www.catalysechange.com 
Please complete this form as soon as possible, as bursaries will be reviewed and awarded within 14 days of being received  Closing date for applications is: 15th July 2021.
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Email *
What is your name *
What is your Date of Birth *
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Your Address *
Mobile phone number *
Please tell us a bit about your situation *
Please can you tell us a bit more about this e.g. where you are studying or working now and what are your plans in September. *
Tell us a bit about yourself e.g. what you enjoy doing most, favourite subjects, dream job/career *
Are you available to attend the Catalyst Summit on 17th, 22nd, 23rd July *
Please tell us in your own words why you want to be a catalyst for change? *
Would you like to have a sustainability mentor for 3-6 months following the Catalyst Summit? *
What would you like to get out of this programme? *
Can we connect with you via Instagram? If so, please provide your user name here: *
Where did you hear about us? *
Ethnicity *
What is your gender *
Please state your reason for applying for a Bursary *
If Low Income, pls state amount
If Other, pls state reason
Would you be happy to provide a short case study of your experiences on our programme? We share this with the sponsor of your bursary. *
Emergency Contact (Parent or Guardian): Full Name, Mobile phone number  & relationship to you                                                                                                                                                                                                                                                                                             *
Do you have any questions or comments for us? *
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