Sutcliffe Foundation Grant Application

Grant Application Form

Please fill the form below accurately and we will contact you soon. **Re-launching 1st September 2024 - Applications submitted before this time may not be processed**
Person or Organisation making the request
Date of application

MonthDayYear
Date
Your Name*
Your Role*
Your Organisation*
Address

Street Address

Street Address Line 2

CityCounty

Postal Code
Phone Number

Area CodePhone Number
Email*
example@example.com
Person for whom the request is made
Name (or other identifier)

First NameLast Name
Gender*
Age*
Connection to Staffordshire or Sandwell*
Any disability or illness
Family circumstances

Additional family members details
- Relationship to applicant
- Gender
- Age
- Any disability or illness
- Relationship to applicant (2)
- Gender
- Age
- Any disability or illness
- Relationship to applicant (3)
- Gender
- Age
- Any disability or illness
- Relationship to applicant (4)
- Gender
- Age
- Any disability or illness
- Financial Circumstances
- Information must be sufficient to establish that they do not have the financial resources to meet the expenditure you are requesting help with and must include:
  1. what their income consists of, whether or not they are on, or have applied for state benefits, and/or local council help including Budgeting Loans/Advances or Local Welfare Provision. We would expect them to have tried these routes first
  2. if the request relates to help with debt we need to know about any debt repayment arrangements and we may need to have a financial statement.
- Financial circumstances*
- Purpose of grant application
  
  What the money will be used for: we need to know what the application would spend a grant of £100 - £1000 on.
- Disability/IllnessRelief of PovertyAccess to Education
- Value of grant requested*
  Maximum £1000
- Purpose of grant application*
- Other relevant information
  
  Any other information you think the trustees should know to help them decide on a grant, including the circumstances which led to the need for help.
- Additional information
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty:

Grant Application Form

Person or Organisation making the request

Person for whom the request is made

Family circumstances

Financial Circumstances

Purpose of grant application

Other relevant information