= Required Information

*Charity Name		Number of Paid Staff
*Address Line 1		Number of Volunteers
Address Line 2		Charity Number (Scotland)
*City/County		Charity Number (England/Wales)
*Postcode		Company Number
Website		Year of Foundation

Main Contact		Alternate Contact
*Title		Alternate Contact Title
*First Name		Alternative Contact First Name
*Last Name		Alternative Contact Last Name
*Email		Alternative Contact Email
*Phone Number		Alternative Contact Phone
*Position Held		Position Held

*Is this a research project

*Anticipated Start Date

*Name of Project

Main Age range of beneficiaries

Project Description (no more than 50 words)

Any other age range of beneficiaries

*Funding Theme

*Total cost of project £

*Will additional staff be employed

Period of funding requested

Amount Applied For in Year One £

Estimated number of beneficiaries year 1

Amount Applied For in Year Two £

Estimated number of beneficiaries year 2

Amount Applied For in Year Three £

Estimated number of beneficiaries year 3

*Total Amount applied for £

Overall Number of Beneficiaries

Main Geographical area served

Any Other Geographical area served

*Do you have a safeguarding policy?
Date safeguarding policy last reviewed	[ 25/04/2019 ]	Details of Safeguarding Review
Last Date of Safeguarding Training	[ 25/04/2019 ]	Who delivered the training?

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