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Small Grant Application Form
About the person completing this form:
First Name
Last Name
Your email
Phone Number
Relationship to recipient
About the person who will benefit from this grant
Recipient – Contact Info:
Recipient – First Name
Recipient – Last Name
Recipient – Email (optional)
Recipient – Phone Number
Address:
Address Line One
Address Line Two
City or Town
Postcode
If the address is outside of Brighton & Hove, please explain their connection to the City?
Application Background
Please briefly describe the recipient’s financial situation
What is the reason for your application? (Why is there a need and what is the medical situation of the recipient)
What item/equipment/service are you applying for?
What is the value of the item/equipment/service?
Is your client in social housing?
Yes
No
Would your client be able to receive a call from BDNAT or a 3rd party to clarify details?
Yes
No
If in receipt of benefits, which ones?
Are there any other details you think we should consider?
