Grant Application Form

Grant Application Form

Questions should be answered in full. Please do not leave boxes blank. You are required to provide documentary evidence to support your application. Incomplete forms will be rejected.
Name of Organisation*
Contact Name*

First NameLast Name
Position held within organisation*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact number*

Area CodePhone Number
Email*
example@example.com
Please state the nature of your organisation*

VoluntaryCommunityNot for profitSocialOther
Please describe the main activities of your group and the service you provide
Please describe the project for which you are applying
Estimated total cost of the project (please specify what the funds will be used for)
Please give details about how your organisation will obtain the balance of funding of the project
Have you received a grant from the Town Council in the past?

YesNo
Please give details of any other grants received from other local authorities over the last two years
Please give details of contributions offered or expected from other sources of funding
Please state the total amount of grant required from the Town Council
What is the anticipated start date of the project?

MonthDayYear
Date
Please describe the benefits offered to the community by the project for which you are applying for funding
Please supply a copy of last financial year's audited accounts and a current bank statement (grant money will be paid to this account)

Cancelof
By submitting the form you confirm that the information supplied is true and correct. You must inform us as soon as possible if the information supplied changes in any way. The funding offered must be used soley for the purposes specified in the application. You must comply with any terms and conditions imposed upon an award by Billericay Town Council, repayment of the grant may be necessary if these conditions are not fulfilled.
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