Grant Application

Name of Individual / Organisation / Charity *

Registered Charity Number (if applicable)

Address Line 1 *

Address Line 2

County *

Post Code *

Contact Name *

First

Last

Position

Telephone *

Email *

Amount Requested *

Aims and objectives of your charity/organisation (including user groups) *

Details of what you need the grant for: *

Outcome: Please tell us how you will monitor and evaluate the success of your project. If you receive a grant, you will be required to report your success. *

Previous applications to any of the Robert Dickie Charitable Trust: Date and amount awarded (if any)

Supplementary information (if required)

Email *

Submit