Funding Application

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Funding Application

Funding provided by Doit4Loui

Section 1- Details of the person making the application

First Name *

Surname *

Address *

Telephone number *

Email address

Local Authority *

Relationship to child *

Section 2 - Details of the child requesting funding for

First name *

Surname *

Age *

Section 3 - Meeting our criteria

Please note working families on low income are invited to apply.
Please tick relevant answer.

Are you on low income? *

Yes

Are you in receipt of any of the following benefits?

Child Benefit

Council Tax Benefit

Income Support

Disability Living Allowance

Working Tax Credit

Housing Benefit

Job Seekers Allowance

Pensions

Income under £15,000

Universal Credit

Other:

Are you able to contribute in any way financially? *

Section 4 - Details for request

What are you requesting the funding for? *

First stage lessons

Maintenance Lessons (must have completed first stage)

Refresher lessons (must have completed first stage)

Have you already registered for lessons? *

Yes

N/A

Have you paid the registration fee? *

Yes

N/A

Section 5 - Previous applications

Have you applied before? *

Yes

If yes, did we offer you a grant and what year?

Family Declaration

Please tick to show that you have read the information and accept our terms and conditions.
Please note that without this agreement we cannot consider the application.

We agree that the information provided is correct and that completing this form does not guarantee the funding.

Required

We will notify Doit4Loui if we are unable to take up the offer of the grant or if we need to cancel.

Required

We will complete a feedback form

Publicity Agreement - To be read and signed by person over 18 years of age.

Please note that any feedback is used exclusively for Doit4Loui newsletters and The Deal. This enables us to generate funding which is essential for us to continue to offer funding. Doit4Loui needs to collate information to help with future fundraising.
Occasionally we will require stories to use on our website and newsletters or for other purposes we deem necessary.
This will raise our profile which could help us to assist more families. We will, where possible contact you prior to the release of any information.

We agree to our circumstances and feedback being used in this way. (no names will be used) *

I agree

I disagree

Signed *

Date *

YYYY

Submit

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