Grant Application Form

Organisation Details

Organisation Name*

Group Leader Name*

Group Leader Email*

Organisation Type*
---Uniformed OrganisationFaith OrganisationSpecial Needs GroupIndependent Youth GroupSports OrganisationOther

If other please state

Activity Provided by Organisation*

Organisation Address

Address Line 1

Address Line 2

City

State

Post Code

Further Organisation Information

Are you currently a LCVYS Member?*
---YesNo

Are you a member independently or through another agency?*
---IndependantAgency

Total age range*

Total Number of Members*
---0-2021-5051-100101-200201-300301-500500+

Times of Service Delivery*

Grant Purpose* -

Please break down costing of grant (upto £750)*

Providing Supporting Documents (DBS Checks, Constitution, Child Protection Policy, Health and Safety Policy, Equality and Diversity Policy)