COMMUNITY CHEST

Application Form

Name of Organisation: …………………………………………………………………….   

Address   ....………………………………..…………………………………………………..

  ......……………………………………………………………………………………

              ......……………………………………………………………………………………

Postcode:                        ………………………………………….

Name of contact person:      …………………………………………………………………….

Tel No:                              ……………………………………………………………………..

Email:                               ……………………………………………………………………..

Aims and purpose of your organisation:

Status of organisation: charity, company limited by guarantee, other non-profit making legal structure, unincorporated with terms of reference/constitution), informal:

Activity/Event/Project Funding Required For: (please show how it relates to the Chest priorities): (if appropriate please attach any additional information)

Who will benefit from the activity/event/project?

How many of those to benefit are residents of the Chest area?

Amount of grant/loan (please delete as appropriate) requested (up to £100):

Note: Please note that in the event of your being given a Community Chest grant or loan you will be asked to provide additional information, including about your banking arrangements.

Signed on behalf of the organisation:

Name and position in Organisation

Signature:

 

Date: