Application for Financial Assistance from our Club

Opportunity for those under exceptional circumstances and who are unable to obtain funding from statutory authorities- local or national

Please note that this completed form should be copied (copy and paste) and sent by email to Rotarian John Brenton for his attention at: johnbrenton19@talktalk.net  


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APPLICATION FOR FINANCIAL ASSISTANCE

Please note that this Application form should only be used when the applicant considers there to be exceptional circumstances.  Please read the CONDITIONS APPLYING TO FINANCIAL ASSISTANCE BEFORE completing the application. 


Full name of applicant

Address of applicant



Telephone number

Organisation ( if applicable)

 Please provide a brief explanation of your need for financial assistance



Please provide a brief description of the project



Please explain why you consider this application to be an exceptional one


How much funding is the applicant seeking?

When is it anticipated that the finance will be required? (month and year)

If the need arises as a result of finance not being available from local government or government sources, please indicate to which department(s) you have previously applied.


Have you applied for financial assistance from another source?  If so, please provide details.


I/We agree to the terms set out, signed:.............................

We suggest that you print a copy of your completed form before submitting.

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Conditions Applying to Financial Assistance

1.If It is agreed that a financial contribution will be made towards a project, payment will be  made direct to the provider and only on production of evidence that the project has been completed and evidence that the full balance cost of the project has been secured and paid by the alternative source.

2. If financial assistance is required towards a school or university project, full details of the project must accompany this Application and if financial assistance is agreed, payment can only be made direct to the provider or charity at a time when the Applicant has managed to achieve full contribution to the project from other sources.

3 An award of funding will only be available for the project identified in the Application and then only on production of any evidence which may be required.

4. Funding will not be available after 6 months of the date of the letter confirming the award.

5.Multiple applications will not be accepted.

6 Any financial assistance will be subject to any conditions attached to the letter confirming the award.

7. It is regretted that payment of any financial assistance  cannot be made directly to the Applicant

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PLEASE EMAIL THE  COMPLETED FORM TO: johnbrenton19@talktalk.net   -   for attention


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