Please note that an application to any of the above Trusts is an application to them all.

PLEASE READ THE GUIDELINES BEFORE COMPLETING THIS FORM

Please complete every part of this application form. If you are unable to complete any section, please give reasons why (e.g. because you are a new group). The form should be typed.

DETAILS OF THE ORGANISATION

Organisation Name: Year established:
Address: Position:
Email: Tel no.:
Contact first name: Contact last name:

OVERALL PURPOSE OF ORGANISATION
Please describe the organisation’s general aims and objectives. You can use your Mission or
Vision statements as a guide to summarising your work here.


REQUEST FOR GRANT
Please describe the reasons for which this grant is requested. If this involves specific items of
equipment, please supply copies of estimates. Read the guidelines BEFORE you start to complete
this section.


SERVICE STATISTICS
Please give relevant information concerning the number of people benefiting from the
organisation’s services currently (e.g. number of attendees, residents, members) and for the
previous year if possible. Please also supply brief details of your staffing resources i.e. both
employees – if any – and number of volunteers.


GRANT REQUESTED
Cost Breakdown:
Cost: Amount (£): Explanation:
Cost: Amount (£): Explanation:
Total Cost (£): Payable to:


FUNDING
Please attach your organisation’s income and expenditure statement and balance sheet accounts
for the last two years. Please comment below on any details in these accounts you may wish to.


FINALLY:
Are you a registered Charity?:
Charity Registration Number:
Do you have a Safeguarding Policy?:
Have there been any safeguarding incident in the last 12 months?
If YES please advise how these concerns were addressed below:

Do you have a management committee?
Do you have a written constitution?
Do you have a bank account with two or more signatories?
Have you applied elsewhere for funding for this project or activity?
If YES please give details of any funding you have secured towards this project:


SIGNATURES
To the best of our knowledge the information provided in this application is correct and we agree
to keep to the terms and conditions outlined in the guidelines should any aid be provided. We
understand that the completion DOES NOT guarantee that any funding will necessarily be
approved. We also agree to contact the Secretary to the Trustees concerning ANY changes to the
details provided on this form.

Signed on behalf of the organisation:

Trustee/CEO Signature: Trustee/Secretary Signature:

Name (typed or blocked capitals):Name (typed or blocked capitals):

Signature date:


Your completed application must be received by 15th of every month to be considered by
the Trustees at their next meeting.

Accounts File Name:

Support Document File Name: