Grant Applications

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Individual Application

This form is to be completed by the person applying for the funding, or by someone authorised to complete it on their behalf. Kindly make sure that you have all the information before starting the application process.

Contact Information

Name

Address

Mobile No

Name of person making the application if different from above

Application Information

Amount you are applying for?

What is the nature of your illness?

When were you diagnosed? required

Who made the diagnosis?

Kindly upload any proof of diagnosis.

Upload File

Upload supported .jpg file (15mb Max)

What will you purchase with the grant?

How will this item/items help you?

Please briefly explain your personal circumstances. This is so that we know that you are in need of the charitable funding.

Is there anything else you would like to tell us? Use this space to tell us the trustees, anything you think will help us understand why you should receive this grant.

Signature

I confirm that the above information is a true and correct statement according to the best of my knowledge...

Signature Name

Signature date required

The trustees thank you for your application and will be in touch soon.

Grant Applications

Individual Application

This form is to be completed by the person applying for the funding, or by someone authorised to complete it on their behalf. Kindly make sure that you have all the information before starting the application process.

Contact Information

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