Enquiry Form

1) Contact Name

2) Job Title

3) Name of Organisation

4) Address

Postcode

5) Telephone

6) Fax

7) Email

8) Are you a registered charity?

yes no
...if yes, Charity Number

9) How did you hear about this service?

10) What type of organisation are you?

National body
Branch of national body
Headquarters of national body
Local Group
Other (please specify )

11) The aim of your organisation/charity (i.e. what does it do?)

12) Is your organisation's work

Innovative
Unpopular/radical
Encouraging self help

13) The project for which funds are required. Please give a brief summary of the proposed project, including details of who the project aims to help, what the principal focus is, and where the project will take place.

14) What type of funding is required?

Organisational running costs (recurring)
Project Revenue (one-off)
Capital items
Building Work
Other (please specify )

15) Amount Needed

16) Please list other funders you have already approached or are in the process of approaching, and the levels of funding applied for or agreed.