Application form

Note: During the Christmas holidays (22 December - 5 January), we do not process applications. Do you make an application during the Christmas holidays? If so, it will take an average of six to eight weeks for your application to be processed.

Application form

"*" indicates required fields

Step 1 of 5 - Start

20%

Facebook

This field is for validation purposes and should be left unchanged.

Have you applied to Leergeld Utrecht before?

Yes, I am familiar with Leergeld Utrecht

No, this is my first time applying

I am a caregiver filling this out on behalf of someone else

What is your family number?

This consists of 4 digits. If you don't know it, you may leave the box blank.

To fill in this form properly, we will ask you three things. That is: information about yourself, information about your child and what you need. Fields marked with an * are compulsory.

Information caregiver

Name of care provider*

First Last

Phone

Email address*

Which organisation do you work for?

Information parents

Salutation*

Otherwise

Name of parent/carer*

First Last

Family situation*

Single-parent family

Two-parent family

Salutation partner*

Otherwise

Partner name*

First Last

Address details*

Street House number City (Utrecht municipality only) Postal Code

Email address*

Phone*

Do you have a U pass:*

Yes

I have a:*

Income from employment

Benefit

Income from work & benefits

No income

I have a:*

Income from employment

Benefit

Income from work & benefits

No income

My partner has a:*

Income from employment

Benefit

Income from work & benefits

No income

Family income*

Income up to € 1,402 net per month

Income up to €2,102 net per month *

* Assessment depends on your disposable income. We will contact you.

Family income*

Income up to € 2,002 net per month

Income up to €3,003 net per month *

* Assessment depends on your disposable income

How many children under 18 do you have?*

Tick which support you get (multiple answers possible):

You don't have to share this. We ask this so we know if we can support you. We would also like to know who we can work with to help you better.

Food bank

Energy surcharge

Neighbourhood team

Other support? Enter below...

Share here a picture of your family's income statement* from the last month (multiple files possible)*

Drop files here or

Accepted file types: jpg, jpeg, jpe, png, gif, docx, pdf, Max. file size: 2 MB.

* such as your pay slip, benefit statement or income tax.

Example: You can download a sample benefit statement here.

Information child

Details of the child you are applying for. (Note: fill in a new application form for each child)

Child name*

First Last

Date of birth*

DD dash MM dash YYYY

Fill in: day-month-year (for example: 5 January 2000 is 05-01-2000)

Gender*

Boy

Girl

Otherwise

What kind of education does your child follow?*

Primary school

Secondary school

MBO, HBO or WO

My child is not yet at school

Which school does your child attend?*

Which group, class or year is your child in?*

Child's U pass number*

Enter the last 8 digits of your U-pass here

Photo of the front and back of the U pass of the child you are applying for*

Drop files here or

Accepted file types: jpg, jpeg, jpe, png, gif, docx, pdf, Max. file size: 2 MB.

Make request

What does your child need right now?*

Bike

Swimming lessons

Sports costs

Laptop

Homework help/ tutoring

Cultural costs (e.g. music or dance lessons)

Squla (toddlers and primary school)

StudyGo (secondary school)

School fees: High school, MBO/HBO/WO

Birthday box from Jarige Job

More info Jarige Job

We can register your family with Stichting Jarige Job. Your child(ren) will then receive a birthday box from this foundation every year. If you choose this option, we will pass on your family's personal details to Stichting Jarige Job. See here for more information.

Swimming lessons

Details when applying for swimming lessons

Has your child started swimming lessons yet?

Yes

Which diploma is your child swimming for?*

Swimming club/pool name*

Did you pay for swimming lessons?

Yes

Your bank account number*

What name is this account in?*

Add the receipt here*

Accepted file types: jpg, jpeg, jpe, png, gif, docx, pdf, Max. file size: 2 MB.

Homework help

Homework help or tutoring: We need a notice from the teacher stating that homework help or tutoring is needed. For more information, see: Homework support - Leergeld Utrecht. Here you can download school's notice for homework/ tutoring support - make sure the teacher, master or mentor fills it out.

Upload teacher's message here*

Accepted file types: jpg, jpeg, jpe, png, gif, docx, pdf, Max. file size: 2 MB.

You can apply for homework help for your child through 3 providers. They are very different. Read all the information carefully first: Application for homework help - Stichting Leergeld Utrecht. Have you made a choice? Fill it in below.

I would like to register my child for:

Asha Foundation (free)

Opportunities Academy Foundation

Double-up group 7 or 8

Double-up VMBO

Laptop

Laptop primary school:

If we approve your application, these arrangements will apply:

Is your child in grade 6, 7 or 8? Then we will reimburse for a laptop of your own.

Is your child(ren) in grades 1 to 5? Then we will reimburse one laptop for them to share.

Laptop high school:

The laptop scheme differs per secondary school in Utrecht. Look for more information per school: School fees secondary education - Leergeld Utrecht.

Leergeld only accepts applications for schools with their own school fund. These are the following schools:

Academy 10

Anna van Rijn College

Ithaka

Leidsche Rijn College

NXT

Zeist Public Lyceum

Public VMBO and MAVO Zeist

Pouwer College

VOLT!

School on the Singel

Trajectum College

Utrecht Municipal Gymnasium

Unic

X11

Is your child at another school? If so, ask the school for help.

Is there already a laptop in the family that your child can use?*

Yes

It involves a laptop belonging to one of the parents or a sibling from grade 1 to 5.

Note: We give out a maximum of 3 laptops per family. If there are more children, they have to share with each other.

This field is hidden when viewing the form

If your child is in grade 8 and will go to secondary school after the summer, please enter here which secondary school he/she will attend. Don't know yet? Then fill in that you do not know.

School fees Secondary school or MBO/HBO/WO

What do you want to request for this child?*

What are the costs of this?*

Sports costs

What does your child want to do?*

At which sports club or association?*

What are your costs per year?*

From when do you have to pay the tuition fee for this sport?*

Cultural costs

What does your child want to do?*

At which music school or association?*

From when do you have to pay the tuition fee for this?*

What is the cost per month or year?*

Check shipping

Have you completed all the questions? If you accept our privacy policy, you can now send your application. We will handle your data properly.

I agree with the privacy policy.

Read our privacy policy here.

I would like to receive the newsletter (optional)

Yes, I would like to receive your newsletter

In the newsletter, we share important information, such as temporary promotions. Sign up if you want to receive it.

Would you like to share any additional information with us?

Here you can enter additional information that may help us with your application

This field is hidden when viewing the form

Use data

Leergeld Utrecht may use my details to process my applications.

Application form