Grant Form



Other Names Known By:

Registered Address:

Correspondence Address:

Registered Charity No.:

Registered Company No. (if applicable):


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




Position of Person Applying:



Number of Trustees:

I declare that the 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 used wholly for the purpose stated above.

Signature:
Position:
Date:



Name of Project:

Location of Project:

Who does your organisation support, please select one or more of the following:

Mental disorder:
e.g. bipolar affective disorder, schizophrenia,
schizoaffective disorder, depressive disorder

Neurodevelopmental disorder:
e.g. ADHD, autism spectrum disorder

Intellectual/Learning disability:

Please provide a brief outline of the project for which you are seeking funding. (This can
be explained in more detail in your project proposal):


New Project or Continuity:
Date Operations Started:
Number of year(s) applying for:
Year 1 Amount (£):
Year 2 Amount (£):
Year 3 Amount (£):
Number of Beneficiaries of the Project:
Amount of Grant Applied for:
Total Project Budget:
How much other part funding have you secured?:

Have you applied to CRH before?:
Is so when did you apply?:
Was your previous application successful?:

Finance
 Accounting Year End:
Total Funds of Charity:
Income for Last Financial Year:

Please outline your grant proposal:


Recent Management Accounts File Name:

Latest Filed Accounts File Name:

Most Recent Accounts File Name. (Draft if not formally approved):