We are committed to making this programme accessible. A limited number of bursary-funded places are available for families who may face financial barriers to participation. Please complete the form below:

Bursary Application

Early Intervention Behavioural Support – Application Information

This application form is for families of young children with autism who would like their child to benefit from practical, individualised and evidence-based behavioural support.

The Playhouse Foundation offers means-tested bursaries to Hampshire-based families to help fully or partially fund our home programmes.

A formal diagnosis of autism is not essential at the point of application. Our trained consultants are able to undertake an assessment of your child’s needs and make recommendations about appropriate support, where a diagnosis is not yet in place.

Family Commitment

Families offered a place on one of our programmes are expected to make a strong commitment to their child’s programme and to working in partnership with the team.

This includes:

providing one clean, suitable living room within the family home that can be dedicated to the programme;
ensuring that the programme can take place consistently within the agreed hours;
actively participating in regular team meetings with the programme team; and
working collaboratively with our consultants and tutors to support your child’s progress.

Funding

All bursaries are subject to means-testing and are awarded at the discretion of The Playhouse Foundation’s Trustees.

Trustees are unable to guarantee funding beyond the first year of the programme. Any continuation of support will be subject to a further review of your child’s needs, family circumstances and the Foundation’s available funds.

To enable the Trustees to assess your family’s financial circumstances, parents applying for a means-tested bursary are asked to provide:

the completed application form;
documentary evidence of household income, such as a P60, payslips or self-employed tax return;
details of savings and other capital assets;
details of monthly mortgage or rental payments; and
details of any other dependent children within the household.

Eligibility is assessed primarily on household income, with consideration given to the number of dependent children within the family and other relevant financial circumstances.

Parents are also asked to provide copies of any professional assessments or reports relating to their child, where available. These help the Trustees and programme team to understand the child’s individual needs and determine the level and type of support that may be appropriate.

Declaration

Parents are required to confirm that the information provided within their application is accurate, complete and up to date.

If information provided is subsequently found to be false, incomplete or misleading, The Playhouse Foundation Trustees reserve the right to review or withdraw any means-tested bursary awarded.

What Happens Next?

Once your completed application form and supporting documentation have been received, our Director will contact you to arrange an informal conversation. This provides an opportunity to talk about your child, your family’s circumstances and what you hope the programme might achieve.

Families who are shortlisted may also be offered a home visit with one of our consultants. This enables the consultant to meet your child in their home environment, gain a better understanding of their individual needs and consider whether a home programme would be appropriate.

All applications are considered on an individual basis by The Playhouse Foundation Trustees.

Child's Information

Child's First Name:

Child's Last Name:

Child's Date of Birth:

Day

Month

Year

Does your child have a diagnosis of Autism Spectrum Disorder?

Yes

Date of diagnosis:

Day

Month

Year

Traits of autism (e.g. non-speaking, sensory issues):

Other medical conditions:

Parent/ guardian 1 contact details

First name 1:

Last name 1:

Email address 1:

Phone number 1:

Parent/ guardian 2 contact details

First name 2:

Last name 2:

Email address 2:

Phone number 2:

Employers name and contact information. If self employed, type of business:

Financial Information

Total gross (pre tax) earnings of both parents/ guardians:

Benefits income:

Pension income:

Maintenance income:

Other income:

Savings:

Other assets:

Mortgage or rent payment per month:

Loans/ overdraft payments per month:

Utilities payments per month:

Travel payments (private or public transport) per month:

Food payments per month:

Other commitments per month:

Select which documents you are submitting to verify your income:

P60 & P11D (if applicable)

Payslip

Reports and accounts

Copy of HMRC tax calculation issued under self assessment

Confirmation of schedule D self employment income from independent accountant

Other

Please upload proof of income

Please upload proof of outgoings

Details of professional assessments (please upload supporting documentation):

File upload

Details of other organisations you may have applied to for a grant:

Have you ever received a type of early intervention programme before? If so, please provide details:

Why do you think that early intervention is best for your child?

Any additional information you feel will help us understand you, your child and family circumstances:

Declaration

We/I have read the notes and have made a complete and accurate declaration of our/my income and outgoings.

We/I accept that it is at the Trustees discretion as to how families are selected, and as to whether families are fully or partially funded.

We/I understand that if we/I am offered a Bursary for our/my child and accept a place for him/her within your Foundation, the following terms

and conditions will apply:

a) to provide one clean living room dedicated to an early intervention programme;

b) to fully participate and attend every team meeting provided by The Playhouse Foundation;

c) to consent to video footage of our/my child in order to present evidence of progress.

The Bursary may be withdrawn or reduced if:

d) we/I have failed to produce any additional information required by The Playhouse Foundation to evidence our/my financial circumstances;

e) in the opinion of the Trustees, our/my child’s attendance, progress or behaviour no longer merits the continuation of the award;

f) we/I are/am more than 14 days in arrears in respect of any amount due and owing to The Playhouse Foundation;

g) there is a material change in our/my circumstances;

h) the Foundation’s resources are insufficient to maintain the level of award;

i) the Bursary will be withdrawn and the value of any amount of the Bursary previously credited against our/my child’s fee account will become repayable to the Foundation forthwith if we/I have fraudulently, knowingly or recklessly provided false information in relation to the award of the Bursary.

I have read and accepted this document.

Signature

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Date

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Month

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