Grant Appliation

Name

Charity Number (if a Registered Charity)

Address (for Correspondance)

Contact Telephone Number

Contact Email

Bank Details (if applicable – Name on Account, Sort Code and Account No.)

Amount Requested (up to £250)

£ 5 £ £ 250

What activity, project, etc. is being undertaken?

How will the Grant be used?

Authorisation

Success

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