Clone of Richmond Rotary Club Trust Application Form

Richmond Rotary Club Trust

Application Form
Applicant's Personal Details
Name*

First NameLast Name
Date of Birth *

DayMonthYear
Date
Age at Time of Application*
Email Address*
example@example.com
Phone Number - Landline

Area Code Phone Number
Phone Number - Mobile
Time Resident in Richmond Area*

Less than 2 yearsMore than 2 years
Applicant's Address
First Line of Address*
Second Line of Address
Town*
Postcode*
Application / Activity / Project Details
What is your Application for?*
What would a grant help you achieve?*
Have you applied to Richmond Rotary Club before?*

YesNo
If yes, when was that, what Grant did you receive and what was it used for?
If successful, how would the current application enable you to progress your education and personal goals?*
Please give details of any other grants required to fund your project/activity.*
How do you intend to record your spending?*
Expected Start Date*

DayMonthYear
Date
Expected End Date*

DayMonthYear
Date
Total Cost of Project, Activity, Application*
£
Amount Requested from Richmond Rotary Trust (Usual max: £500)*
£
Any Other Information
(Max 200 words)
If your Application is successful please indicate how grant should be paid.
By Bank Transfer to:
Account Name: Account name
Sort Code: Sort Code -   Sort Code  -   Sort Code
Account Number:    Account number
By Cheque payable to: Name
I agree that the information contained in this form may be circulated to the Trustees of Richmond Rotary Club Trust on condition that it is used solely for the purpose of assessing my application and that the information is not shared with any other individual or organisation. I confirm that the information contained on this form is true and agree to provide receipts for expenditure if required. I also promise to report to Richmond Rotary Trust on the use of any grant within four months of receipt.*

I confirm and agree
Should be Empty:

Richmond Rotary Club Trust

Applicant's Personal Details

Applicant's Address

Application / Activity / Project Details