Thank you for applying for a grant from HEART UK – The Cholesterol Charity. Please complete the following information and return the form to: Jane Kendrick - .
General Information – Applicant contact details
Job title:
First Name:
Surname:
Work Name:
Work Address:
Post Code: / Country:
Contact Telephone Number: Work: Mobile:
E-mail address:
Project Information
Name of project:
Anticipated start date of project:
Explain in no more than 100 words a summary of your project:
Please give a detailed description of what you will be doing & how & when the funds will be used:
Please provide an itemised budget setting out what the funds will be used for and when:
Explain how will this fit with HEART UK’s objectives?
Payment Information
Amount (value) requested: (up to £3,000 per annum)
How many years are you looking for funding (up to 3 years)
What is the anticipated total cost of the project? (GBP)
Are you seeking funding from any other sources **Yes No
If yes to the above, please state name of institution(s):
Have you previously applied for a grant for this project? **Yes No
If yes to the above, was this rejected and if so why? **Yes No
PROFESSIONAL MEMBERSHIP
In order to be awarded a grant from HEART UK, you must be a Professional Member of the organisation.
Are you currently a professional member of HEART UK **Yes No
To become a professional member, please see our website for further information and complete the form.
PATIENTS & SUPPORTERS OF HEART UK
In order to be awarded a grant from HEART UK, you must be a regular supporter of the organisation.
Are you currently a supporter of HEART UK **Yes No
To become a regular supporter, please see our website for further information.
* Delete as appropriate **Double left click on box to check it