Financial Support Grant | SURREY HEATH BOROUGH COUNCIL

This form should be used by individuals or parents/carers of individuals in Surrey Heath who find cost a barrier to participating in sport. This grant may be used towards ongoing costs such as club membership/subs, or one-off costs such as purchase of equipment. It is designed to support those who meet and can evidence one or more of the following criteria:

On Jobseekers Allowance
Incapacity Benefits
Free School Meals

Please note that all applications must be endorsed by a coach (or senior club officer) who can be contacted for verification.

Applicant Name *

Address

Country *

Address 1 *

Address 2

Town/City *

Postcode *

Email Address *

Club/Organisation *

Sport *

Name of Coach *

Amount of grant you would like to apply for (max £250): *

Please provide a break-down of costs for which Surrey Heath Sports Council’s financial assistance is required:
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost
Item Required	Number of items	Total Cost

Total *

If the costs are greater than the grant being applied for, how is it proposed to raise the balance of the funds required? *

Have you approached other organisations to assist with funding? Where applicable, were you successful and how much funding have you received?
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded
Organisation Approached	Successful?	Funding Awarded

Total *

Please provide an explanation of why this grant is being applied for. Please include details of your financial situation and any organisations you might be working with e.g. family services, carer support, job centre. *

Please add attachments

Please attach supporting documents to evidence that you are in receipt of either job seekers allowance, incapacity benefits or free school meals

Add a new file *

Files must be less than 32 MB.
Allowed file types: gif jpg jpeg png txt rtf pdf doc docx xls xlsx.

I confirm that the club/organisation supports this application

I Agree

Please note that the information provided in your application will be processed by Surrey Heath Borough Council officers and made available to the Committee of Surrey Heath Sports Council.

I declare that the information given above is, to the best of my knowledge, correct and I understand that any misleading statements or false information given during the application process may render the application invalid and any grant paid will be returned to Surrey Heath Sports Council.

I give permission for Surrey Heath Sports Council to publicise my grant should I receive one, and the following information may be put on the Surrey Heath Borough Council website: club, sport, club details and reason for grant (please delete any information you do not want to appear) . I understand that I may submit a photograph to be added. I accept that by submitting this form I may be contacted regarding the Surrey Heath Sports Awards.

I understand that submitting an application does not guarantee a grant award, and that all grants are made at the discretion of Surrey Heath Sports Council.

The information provided will only be used for the reasons outlined above. I understand that if I have any concerns in regards to the above, I should contact a member of the Surrey Heath Sports Council before signing.

Please tick to indicate that you agree with the declaration above: *

I Agree