Form

Funding Application Form

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

QUALIFICATIONS
Qualifications achieved:
Working Towards:
SUPPORTING INFORMATION :*
Please include as much information as possible to support your application (Minimum of 500 words) e.g. details about yourself/future plans/personal circumstances including age and number of children; employer/job role/number of hours worked weekly; length of unemployment; any benefits received; enrolment on any named course, start and finish dates/years of study and qualification to be achieved; categories, age and ethnic profile of individuals supported by your organization and why application request is necessary; Business start-up details; cultural exchange details; research details to improve community relations/cultural/performing arts project details.
GRANT FUNDING REQUIRED:*
Please include what you are applying for; the total cost of the item and how much grant funding is required; whether you have applied for other funding sources; what will happen if you do not receive the funding grant requested.

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

PERMISSION TO USE YOUR INFORMATION
The Wolverhampton African Caribbean Foundation Trust will never share your information to any third party unless we have your permission or the law requires us to do so. Under data protection legislation and General Data Protection Regulations (GDPR) we are seeking your permission to use your information.
I give permission:*
- Yes
- No
Digital signature
First