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The Bowley Charity

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For Vulnerable Children in Watford and Three Rivers

GRANT APPLICATION FORM

Please type the application form and complete it fully or the application may not be considered.

Handwritten forms are no longer accepted. Please email the form to pam.hill@.uk.

|REFERRER DETAILS (Self referrals are not accepted) |

|Referrer’s name: |      |Job title: |      |

|Email address: |      |Tel: |      |

|Organisation’s name |      |

| and address: |      |Postcode: |      |

|Date of application: |      |Date of your last home visit: |      |

|Date of last successful application (if any) to Bowley on behalf of this family: |      |

|Has application been made to any other funding source for this family? | |

|Please provide details: |      |

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|APPLICANT DETAILS (Must be housed or have a secure offer of housing in Watford or 3 Rivers) |

|District of residence: | | If Other please give an explanation overleaf. |

|Parent/Guardian’s name: |      | |

|Address: |      |Postcode: |      |

|Number of bedrooms: |      |Permanent or temporary accommodation: | |

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|CHILD DETAILS |

|Forenames: | |Gender: | |Date of birth: | |Relationship to applicant: |

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|TOTAL HOUSEHOLD INCOME (per week): |      |Please provide details below: |

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|TOTAL HOUSEHOLD EXPENSES (per week): |      | |

| | |Please provide details below: |

|Rent/mortgage: |      |Council tax: |     |Water/electricity/gas: |     |

|Food/shopping: |     |Phone/mobile/TV: |     |Transport: |     |

|Loan repayment: |     |Other (please state): |      |

|Does the family have any debts? If yes, please state the total amount outstanding: |      |

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|INTENDED USE OF GRANT List in priority order. Include multiples in Description eg. 2 beds x £81. |

|Include mattress if also needed. A gas cooker will not be granted unless a case is made below. |

|Item Description: |Cost: |Argos catalogue details (if possible): |

|      |      |Page no:      Item code:    /     |

|      |      |Page no:      Item code:    /     |

|      |      |Page no:      Item code:    /     |

|      |      |Page no:      Item code:    /     |

|Total: |      |Is delivery required? | |

|REASON FOR APPLICATION Please summarise the family’s circumstances and why each listed |

|item is needed. If the family is in temporary housing please provide evidence of local housing offer. |

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|Is there a CAF for this family? | |(For general information about CAF call 01438 737575). |

Registered Charity Number: 212187 bowleycharity.btck.co.uk 08/2017

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