Form

Funding Application Form

Please read the funding and eligibility criteria before completing this form

Step 1 of 4

PERSONAL DETAILS
First Name*
First
Last Name*
First
Title*
Date of birth*
MM slash DD slash YYYY
Name of Voluntary Group/Community/ Organisation/Business Start-up (if appropriate):
Main contact :
Address*
Town/City*
Phone*
Email*
Do you/ your organisation fall into or support individuals in any of the following categories? Please select as appropriate:
- Lone Parent
- Unemployed
- Student
- In low Paid Employment
- Other
Write Here For Others:
Ethnic origin

REFERENCE 1
Name*
First
Email*
Address 1 Address 2 City County Post Code
REFERENCE 2
Name*
First
Email*
Address 1 Address 2 City County Post Code
DECLARATION
I declare that the information given in this application is accurate. I further declare that if any of the information submitted in this application turns out to be false, I agree to repay all funds granted to me by the Wolverhampton African Caribbean Foundation Trust should the organisation request repayment.
Date
MM slash DD slash YYYY
Digital signature*
First