Get Set Go! Grant Application
About You:
Applicant's first name (the person who will benefit from the grant)?
Applicant's last name (the person who will benefit from the grant)?
If this form is being completed by someone other than the applicant, please provide your details below.
Name
Relationship to applicant
Telephone number
Email address
What is the current address of the person who will benefit from the grant?
House/flat name or number
Street name
Town/City
County
Postcode
Your preferred contact details
(the person we will contact about the grant)
:
Email address
Phone Number
Age (of the person benefitting from the grant)
Disability (of the person benefitting from the grant)
Your Activity
What would you like the grant for? Include the exact equipment, cost breakdown and website links if buying online.
How much would you like us to give you? (between £100 and £1,000)
In the applicant's own words if possible, why would you like the piece of equipment (what will you do with it and how will it help you/make you feel)?
Optional: if the applicant would like to draw a picture to show what the equipment would mean to them, please tick yes below and email the picture to info@somersetcf.org.uk or post to Somerset Community Foundation, Yeoman House, Bath and West Showground, Shepton Mallet BA4 6QN (include the reference Get Set Go!)
Yes
No
Have you applied anywhere else for funding (if this application doesn’t cover the full cost)
? If so, how much have you raised so far? If you haven't raised any money yet please tell us what your plans are for this or how you will cover the remainder of the cost of the equipment.
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Is there anything else you would like to tell us?
Declaration
I confirm that, if my application is successful: - the grant for which I am applying will be used solely for the I have described in this application - I will provide feedback on how the grant has helped including photographs - any unused funds will be returned to Somerset Community Foundation.
Enter your name below to give your agreement to the above
.
Please let us know how you heard about this opportunity.
Contact Information