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GoPI3Ks Funding Application Form
Please complete the following sections, if you have any problems please contact us at:
gopi3ks@yahoo.com
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Email
*
Your email
Applicants name & address:
Your answer
Applicants phone number & email address:
Your answer
Has there been a medical diagnosis of PROS (PIK3CA Related Overgrowth Spectrum) If possible please provide evidence from a relevant medical professional.
Your answer
Please tell us what the funding is needed for:
Your answer
Who would benefit from this and how?
Your answer
How much does this cost? (Please provide details by attaching evidence to either an email application or via a postal application:
Your answer
Have you requested any funding from any other charity?
Yes
No
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If you have applied for funding from another charity, Please give details of the charity and how much funding have you applied for:
Your answer
If approved, GoPI3Ks would like to use your funded event/item for marketing and advertising purposes in our newsletter, please advise if you consent to this and pictures being taken and sent to GoPI3Ks:
Yes
No
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Please sign and date the application form
Your answer
A copy of your responses will be emailed to the address you provided.
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