Name of the child:
(a) Gender:
MaleFemale
D.O.B:
Child’s main address:
Post Code
Please describe the reason a grant is being applied for:
Please tell us how this will improve the wellbeing/educational outcomes of the child:
Applicant’s name and title:
Applicant’s relationship to the child:
Applicant’s address for correspondence:
Postcode
Applicant’s telephone no:
Applicant’s mobile no:
Applicant’s email address (important):
Does the child live with the applicant?
YesNoPart Time
Item(s)/service required:
Grant requested from Charity World: £ (Maximum £300)
a) Have you approached the local authority for funding?
YesNo
Account Number:
Sort Code
Please give any additional information which you think would be helpful to us in considering your request:
Signature:
Date: