Grant Application

Grant Application
Office use only
Date Received

MonthDayYear
Date
Date Paid

MonthDayYear
Date
Fund
APPLICANT INFORMATION
Name of person filling in the form on behalf of the applicant*
Title*
Name*

First NameSurname
Age*
Date of birth*

MonthDayYear
Date
Gender*
Nationality*
Religion
Ethnicity*
Marital Status
Young persons Current Address*
Town*
County*
Postcode*
Email Address*
example@example.com
Are you in receipt of benefits*
Type of Cancer*
Date of Diagnosis*

MonthDayYear
Date
Treatment Hospital*
Is this a relapse Secondary Cancer Diagnosis
REASON FOR THE APPLICATION
Amount requested*
Save in exceptional circumstances, this may not exceed £500
Reason for the application*
Save in exceptional circumstances, this may not exceed £500 Reason for the application:
ABOUT YOU
Please tell us about yourself why you are applying for a grant and how you would propose to use it, if successful*
Please provide a detailed breakdown of how the grant would be spent*
Have you applied to any other charities for financial support*
If yes, please name the charities that have helped you, and how they supported you
Please include documentary evidence to support planned spending eg quotes invoices etc
PLEASE PROVIDE DETAILS OF YOUR HEALTHCARE PROFESSIONAL
Title*
First name*
Last name*
Job title*
NHS Email address*
example@example.com
Phone*
Format: (000) 000-0000.
THE TOM BOWDIDGE YOUTH CANCER FOUNDATION
Where did you hear about our work*
The Tom Bowdidge Youth Cancer Foundation runs regular campaigns to help raise funds to support young people and families like yours. This would mean sharing a photo of yourself alongside your story. Is this something you agree to?
The Tom Bowdidge Youth Cancer Foundation shares stories on social media, the website, and with donors and funders about how their donations have made a difference to young people living with cancer. Please confirm if you would be happy for us to share your story and/or a photo.
Please put Yes or No in the box*
Please put Yes or No in the box*
BANK DETAILS
Please provide your bank details for use should your application be accepted
Bank Name*
Account Holders Full Name*
Account Number*
Sort Code*
SIGNATURE*
Date*

MonthDayYear
Date
I certify that the above information is accurate, and I understand that any misleading or false information will result in Tom Bowdidge Youth Cancer Foundation terminating this application for support.

Please note that if you are under 18, this form must be countersigned by your parent or guardian. Signature:
ParentGuardian Signature
Date

MonthDayYear
Date
Please return this application by post to 9 Firmins Court, West Bergholt, Colchester, Essex, CO6 3BQ or nikkibowdidge@tombowdidgefoundation.org

If you are completing this online, please press submit.

We use your personal information to provide the information, support, services, or products you request. We do not sell, share, or swap your information with any third party to send them marketing information. When we collect your personal information, we use strict procedures and security features to prevent unauthorised access. However, no data transmission over the internet is 100% secure. As a result, while we try to protect your personal information, the Tom Bowdidge Youth Cancer Foundation cannot guarantee the security of any information you transmit to us, and you do so at your own risk. If you're 16 or under, in some circumstances, we may refuse certain services unless we have your parent/guardian's permission. You can ask us what information we hold about you by contacting hikkibowdidge@tombowdidgefoundation.org or calling 07771 646654

The Tom Bowdidge Youth Cancer Foundation is a charity registered in England and Wales (1156553)

9 Firmins Court, West Bergholt, Colchester, Essex, CO6 3BQ

instagram.com/tombowdidgefoundation

facebook.com/thetombowdidgefoundation
FUNDRAISING REGULATOR
Please put Yes or No in the box*
Should be Empty:

Grant Application

APPLICANT INFORMATION

REASON FOR THE APPLICATION

ABOUT YOU

THE TOM BOWDIDGE YOUTH CANCER FOUNDATION

BANK DETAILS

FUNDRAISING REGULATOR