Grant Application Form

Charity Name:

Address of Head Office:

Registered Charity No.:

Correspondence Address:

National or Local Charity:


In no more than 30 words please explain what your charity does:


Contact First Name:
Contact Last Name:
Contact Email:
Contact Telephone No.:

Have you applied to the Peter Kershaw Trust previously?:

If you have applied previously, when was the last time you did this?:

Was your application successful?:

If your application was successful how much was the grant you recieved?:


Do you have a safeguarding policy?:
Have there been any safeguarding concerns raised in the last 12 months?:

What is the name of the project?:

Where is the location of the project?:

In no more than 250 words please outline the project of which you are seeking funding?:

What is the total cost of the project?:

Please indicate the funding amount sought from the Peter Kershaw Trust:

What is the duration of the project?:

What other part funding have you secured?:


I declare that information given in this application is true and accurate to the best of my knowledge. I acknowledge that should
my application be successful any sums given will be use wholly for the purpose stated above.
Signed:
Position:
Date:

I have enclosed a copy of the latest financial statements:

The space below is to allow you to elaborate on the outline given above (this should be no more than the space provided). Please
give details, where appropriate, of the following; number of beneficiaries who will be helped as part of this project, the impact
that this grant will have, any risks associated with the project (e.g. financial etc.), any sustainability plans:


The space below is for you to porvide details of how any safeguarding concerns raised in the last 12 months were addressed: