APPLICATION FORM

Name*

Prefix

First

Last

Date Of Birth*

First Line of Address*

Second Line of Address (optional)

Town

Post Code*

What do you want the grant for?*

Please describe in detail why you need this funding and what you want to do with the funding.*

Project Cost (Max £150)

Include a breakdown of what you plan to spend your grant on:

Item/Activity*

Item/Activity

Cost (£)*

Cost (£)

Project Total (£)*

This is the total amount your project will cost

Are you seeking funding from any other organization?*

Yes

Who are you seeking funding from?*

If you are successful, what date will your money be spent by?*

To be completed by the Adult from the organization supporting this application.

As an adult you will be legally responsible for this project and will be accountable.

Please ensure you read through this application carefully before you sign.

Name

Prefix

First

Last

Relationship to this young person?*

Organization Name

Organization Position

Organization Address

Contact Name

Contact Email address*

Can you confirm the young person is from the disadvantaged criteria stated.

Yes

Please note: Where possible Kids in Rossendale will directly purchase the goods and services requested. If an individual cheque is required, it will be paid into the support organisation’s account. You will be responsible and accountable for this funding and expected to provide evidence that the funding has been used for the purpose for which it was intended.

Signature*

Please enter your name.

Date

A copy of your application form will be emailed to you for your records.

When we receive your completed application Kids in Rossendale will then check it to see:
• If all the information on the application form has been completed
• If your project seems well thought through and planned
We may contact you for more information.
The form will then be given to the committee who will assess it against their guidance and criteria.
Kids in Rossendale will inform applicants of the outcomes of their application within two months of receipt of the application
(wherever possible) and will agree with the adult supporter how the funding will be issued.

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