INDIVIDUAL Funding Application Form

INDIVIDUAL Funding Application Form

y-notts.org.uk Ref .

(0115) 9100838

PO Box 9065 Nottingham NG4 9BH

Registered Charity 224651

INDIVIDUAL Funding Application Form

  • Grants will be given on successful application, according to priority and availability of funds.
  • Applications are accepted at any time throughout the year and the committee will study the application within about two to four months, provided you have included all of the requested information.
  • You may be invited to an interview as part of the process.
  • It is strongly advised you read the guidelines carefully to ensure you meet the criteria for eligibility.

1. PERSONAL AND CONTACT DETAILS
Title: Mr / Miss / Mrs / Ms Other: / Gender: Male / Female
First name(s):Surname:
Age:Date of birth:
Qualifications so far:
Contact details for correspondence
Email:
Telephone number(s):
Address:
Previous address (if moved within last 3 years):
2. GRANT REQUEST
a) What do you want to do, and why (max 100 words)?
b) How do you plan to do this?
c) If this includes a training course, please provide details here.
Name of course:
College/course provider’s name:
College/course provider’s contact email and tel:
College/course venue:
Start date:
Finish date:
d) How much are you asking us for (not exceeding £3,000)?TOTAL / £
NB If any IT equipment is being requested – please click below to attach an additional form with information

Please list the breakdown of amounts totalling the amount above (insert rows or continue on extra sheet if needed):
Item/Activity / Amount £
3. OTHER FUNDING
a) Have you applied for grants from anywhere else? / Yes / No
i) If so, please list other grants or donations you have been awarded or are waiting to hear about:
Name of organisation/individual / Amount £ / Status
Awarded / Denied / Awaiting Decision
Awarded / Denied / Awaiting Decision
Awarded / Denied / Awaiting Decision
Awarded / Denied / Awaiting Decision
ii) If not, why not? Have you looked into other possible sources of funding your plans in any way? Please explain.
4. FINANCE
a) Please provide details of your income here (include wages, benefits, parental support, capital income etc). Please send copies for proof (scan and email with your application ideally).
Income source: / Amount £ / Frequency
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
Weekly / Monthly / Other (specify)
b) Do you have any savings?
If you do, how much (please enclose copy of bank/building society statement)? / Yes / No
£
c) Do you have any dependents? / Yes / No
d) Do you live with parents / partner / spouse ? Yes / No
If so, please state who, and describe briefly how you share living costs etc.
5. OTHER
a) How/where did you hear about us?
b) Anything else you’d like to tell us in support of your application (max 100 words)?
6. REFERENCES
Please provide details of 2 people who support you in your application with at least 1 educational if this is for a course:
Referee 1 (educational or professional) / Referee 2 (personal)
Name:
Job title:
Connection to project:
Connection to applicant:
Email:
Tel/mob:
Address: / Name:
Job title:
Connection to project:
Connection to applicant:
Email:
Tel/mob:
Address:
7. DECLARATION
The information I have provided is an honest and accurate representation of my situation. By submitting this application form I agree to abide by the terms and conditions detailed on any grant letter sent by y-notts. I understand that I will be expected to monitor expenditure and provide y-notts with receipts and invoices as appropriate. I also give y-notts permission to record information given on this form electronically and understand that personal information will be treated confidentially. This information will only be used for deciding upon a grant award, customer care, publicity, and monitoring.
Signed (typed is suitable for email applications):
Date:

Please submit your application in one of the following ways:

1) Email Word or Rich Text Format documents to

(NB You can email your application form and submit supporting documents by post if unable to email files or scan and email papers as pdf or jpg)

2) Post (ONLY if email is not possible) to PO Box 9065, Nottingham NG4 9BH, hand written application forms take longer to process

We will acknowledge receipt via email.

FOR OFFICE USE
Date received:
Forwarded to trustees:
Decision amount:
Applicant informed date:
Payment amounts and dates:
Date due to complete by:
Date actual completion:
Other:
Date file closed:

1190517