Application – Online Form

Name*

Organisation

Position Held

Email Address*

Phone number*

Address*

Project (Please describe in detail bearing in mind the aims of the Trust Fund - see Guidance page on the website for more information).*

What is the total cost of the project?*

What other financial support do you have?*

What other applications have you made (in particular to other Charitable Trusts in the City of Lichfield) and when do you expect you will know the outcome of those applications?*

Have you received a grant from this Trust in the preceeding three years?* Have you received a grant from this Trust in the preceeding three years?* YES NO

Amount of grant requested?*

To whom should a cheque be made payable?*

DECLARATION (please read carefully and then tick all 6 boxes below): * DECLARATION (please read carefully and then tick all 6 boxes below): * 1. I declare that the information given in this application is true to the best of my knowledge, information and belief.

2. I agree to tell you if any other financial support is given or promised in respect of the project between the date of the application and the Trustees’ meeting.

3. I agree to reimburse the Trust for any money received from the Trust in the event of the money raised for the project exceeding the anticipated costs thereof and as hereinbefore stated.

4. I agree to you enquiring of other Trusts in Lichfield as to whether or not they have or are likely to make a grant in my favour.

5. I agree to provide a copy of the last audited accounts with my application (organisations only).

6. I agree to abide by the conditions of grant (see Guidance Note 4 on the Guidance page on the website).