Name *

First Name

Last Name

Date of Birth *

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DD

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Phone

Parent/Guardian phone number if under 16

Country

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Address of School/College *

Address 1

Address 2

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Teacher's Name *

First Name

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Teacher's Name *

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GDPR and Data Protection Consent *

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

GDPR Consent Agreed

Name of Parent/Guardian

First Name

Last Name

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 Agreed

Terms & Conditions Acceptance *

By submitting your application, you confirm that you understand and agree to the following: o The research project should be submitted by 31st September 2025. o 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. o You will be named in any publications or presentations related to your work. o You will commit to working on the project over the summer, completing the final paper by the deadline.

I agree to the terms and conditions