Download Grant Application Form - Tottenham District Charity

TOTTENHAM DISTRICT CHARITY
GRANT APPLICATION FORM
Please complete in black ink or type
Applicant’s Details
Surname:
Address:
First name:
Tel No:
Age / DOB
How long has applicant lived in Tottenham? (please give dates)
previous address or addresses if less than 3 years
Amount of grant requested:
Note: Advocates, helpers and supporters need to be made aware of our requirement
for a specific proposal and estimates must be provided. A maximum grant of £400 is
paid.
Purpose of grant:
If assistance has been received from any other Charity or Social Security
loan please give details including amounts:
Has applicant received a grant from the Charity before?
If yes please specify when and amount
Yes/No
Please give details of family or other persons living with applicant and
their ages:
Please note:
To apply for a grant applicants need to have lived in Tottenham for 3 years
continuously.
Please provide supply supporting reasons for the application:
Details of household’s monthly Income
Applicant
Partner
Other family
Members
Pension
Wages
Housing Benefit
Other benefits i.e
Child benefit
Other (please
specify
TOTAL
Details of household’s Expenditure
Weekly
Monthly
Rent/Mortgage
Gas/Electric
Food
Telephone
Travel
Other (please
detail)
TOTAL
Signature of applicant
Supported by ………………………….
Date………………
Date …………….
E-Mail …………………………….
Organisation / Position held………………………………/………………………..
Address………………………………………………………………………………
Current policy includes grant awardable for:
basic furniture; ‘genuine hardship’; education; recuperative holiday; house decorating or repairs;
carer transport
PLEASE NOTE THAT IT IS ESSENTIAL THAT THIS FORM IS COMPLETED IN FULL. IT IS NOT
THE POLICY OF THE TRUSTEES TO AWARD GRANTS FOR THE PAYMENT OF BILLS OR
ANY DEBTS
Please send completed forms to [email protected] or by post to CLERK TO THE
TRUSTEES, C/O CAROLYN BANKS, TOTTENHAM DISTRICT CHARITY, PO BOX 365,
LOUGHTON, ESSEX IG10 9EU.