Organisation Information

• Name of Organisation:  
• Registered Charity Number:
• Does Your Organisation Work in the County of Essex, the Unitary Authorities of Southend-on-Sea or Thurrock or the London Boroughs of Newham, Barking, Dagenham, Havering or Redbridge? Yes No  
• Address :  
• Post Code:  
• Telephone: (inc Code)  
• Website: http://
• E-Mail:    
• Name of Contact:  
• Aims of Organisation: (15 to 100 Characters)     
• Who are the typical beneficiaries of your organisation?: (15 to 100 Characters)     
• Where does your organisation work (Geographical area, setting e.g. hospitals): (15 to 100 Characters)     

Extracts from audited accounts (we require the following:)

• Total Income, Last year's Accounts: £     
• Total Expenditure, Last year's Accounts: £    
• Total Charitable Expenditure for the Year: £    
• Total Expenditure on Fundraising for the Year:£    
• Is your budget for the current year increasing, decreasing, staying the same? Increasing Decreasing Staying the Same  

Grant Information

• Approximately how many people benefit from your organisation? 1 to 10 11 to 50 51 to 100 101 to 200 201 or more  
• Why do you think your organisation qualifies for a grant? (15 to 300 Characters)     
• Describe how you will spend any grant made:  (15 to 300 Characters)   
• Total amount required for this project/appeal: £    
• Amount already raised: £    
• with names of Donors: (Max 4)
• Grant amount you wish to apply for:£    
• If you were awarded £500 from the Trust, how would you raise the remainder for the project? Please include names of other sources applied to. (15 to 200 Characters)     

References (please supply the Names and Addresses of two referees)

One Name:   Address (No., Street)   Town/City County Post Code   Phone:   E-Mail:

Two Name:   Address (No., Street)   Town/City County Post Code   Phone:   E-Mail: