Grant Application Form

Organisation Name*

Group Leader Name*

Group Leader Email*

Organisation Type*

If other please state

Activity Provided by Organisation*

Address Line 1

Address Line 2

City

State

Post Code

Are you currently a LCVYS Member?*

Are you a member independently or through another agency?*

Total age range*

Total Number of Members*

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)