BFF Grant Application Form
This is the application form for submitting family grant & charity/organisation grant requests to Batten Fighters Forever. Please complete all fields and include as much detail as possible to inform the Trustees of the grant requirements.
Contact
Details:
Full Name of person completing the grant application
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
County
PostCode
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Who are you applying for?
*
Please Select
A Batten child
A charity or organisation that supports children with Batten Disease and their families?
Name of Batten child or if applicable name of charity/organisation
*
Age of Batten child (years)
*
Please Select
under 1 year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20+
N/A - Charity/ organisation
Batten Variant
*
Please Select
CLN1
CLN2
CLN3
CLN5
CLN6
CLN7
CLN8
Adult Onset NCL
N/A - Charity/ organisation application
Relationship to Batten Child
*
Please Select
Parent
Carer
Unrelated
N/A - charity/ organisation application
Have you applied for BFF grant before?
*
Please Select
Yes
No
Reason for grant application - Please be specific and include as much information as possible
*
If the grant is awarded what impact will it have on the Batten child or Batten community?
*
Grant amount application for £
*
Date Grant needed for
*
-
Month
-
Day
Year
Date
Will the grant amount requested cover the entire cost?
*
Please Select
Yes
No
If not, what percentage will be covered by the grant
*
Have you received professional advice regarding the reason for your request?
*
Please Select
Yes
No
Details of professional advice related to the grant request
*
Include letters of recommendation from medical professionals
Details of the procedures in place to ensure that the grant monies will be used in accordance with the purpose for which it is awarded:
*
Example - copies of all receipts will be provided to BFF for inspection
Batten Fighters Forever are focused on raising awareness of the needs of families and organisations supporting children with Batten Disease. By sharing examples of the support that the charity provides on the BFF website and Facebook page we hope to encourage more fund donations as well as encourage more applications for support. Please confirm below that you consent to BFF including details of the support that the charity provides as a result of this application on the BFF website and Facebook page. You will be provided a draft and opportunity to edit prior to publication
*
Please Select
Yes
No
By signing the box below, I certify that I undertake to comply with the terms and conditions of the Grant Making Policy, including any specific terms or conditions made by the trustees, which will be communicated to me in writing if the grant application is approved.
Date
*
-
Month
-
Day
Year
Date
Continue
Should be Empty: