1.1 Please provide your contact details :


BroadlandYAB
Individual Application Form
Notes
Use this form if you are an individual applying:
  • For a training award
  • To the transport fund
  • the maximum grant available is £300
  • The grant cannot be used for costs that have already been incurred
  • The grant should be used within 12 months of the award
  • A short report and evidence that you have spent the grant (receipts) will be required.
1. Your details
Name
Date of Birth
Daytime Tel No.
Mobile No.
Email
Correspondence address
Town
Post Code

1.4 Please provide the contact details of an adult who is able to support your application

This is essential if you are aged under 18

Please note the personnamed here may be contacted to verify details of your application

Contact Name
Correspondence address
Town
Post Code
DaytimeTel No.
Email
Tell us how this person knows you (for example youth group leader, teacher, employer, tutor) :

1.5Are you applying for (tick one only)*:

For a training award
To the transport fund

* If you wish to apply to more than one fund please complete a separate application for each

1.6Tell us how you would like to spend a grant of up to £300

1.7Is there a specific date by which you need the grant (e.g. a course start date)

1.8How would this grant help you, now and in the longer term?

1.9 Please tell us why this cost cannot be covered by other means

2. Budget

2.1 How much money are you requesting from this Fund £

Please attach evidence of costs – this could be a copy of a letter or email, or a print out of a web page.

Does this sum cover the whole cost of your planned activity? If not, tell us how you will cover the remainder:

3. Payment details

Grant payments may be made direct to the retailer/ service provider where appropriate, or to the applicant by cheque – this will be confirmed as part of the grant offer

3.1 Your Bank Details

Payee name
Name of Bank/building society

4. Declaration

  1. I certify that the information in this application is correct.
  2. If the information in the application changes in any way I will inform Norfolk Community Foundation immediately.
  3. I give permission for Norfolk Community Foundation to record the information in this form electronically and to phone, mail or email with information about its activities and about funding opportunities.
  4. I agree to abide by the terms and conditions of the grant awarded and understand that any offer of a grant will be subject to your proposed work remaining within grant criteria.
  5. I agree to participate in monitoring, auditing and evaluation related to these funds

Signature
(Please sign)
Name
(Please print) / Date

Please return this formby post to:Norfolk Community Foundation, St James Mill, Whitefriars,

Norwich NR3 1TNor by email .

If you have any questions, please contact the Grants Team on 01603 623958.