Welcome to Computershare
Donation Application FormNotesPlease complete this form in order to apply for a donation. The more information you give us the more likely it is your application will succeed. In particular please highlight the extent to which the donation will help ease financial difficulty as this is one of the key criteria we use when considering applicationsPlease print this application form and sign it. You can then either scan the completed form and return it to us electronically, or you can send it in the post to: Lee Usher, Portfolio Servicing Team, Computershare Loan Services, North of England House, 1 Grayling Court, Doxford International Business Park, Sunderland, SR3 3XGYour OrganisationOrganisation NamePlease use the registered name of the charityContact NameAddressPhone NumberEmailWebsitePlease include a URLRegistered Charity NumberCharity MissionPlease outline the mission of your organisationYour Proposed InitiativeProject/InitiativePlease outline the project or initiative that the donation will contribute towardsProject AimsPlease outline the aims of the project or initiativeWho will benefit?Please let us know who will benefit from the donationHow the donation will be usedPlease include a breakdown of how the donation will be usedSustainabilityPlease outline how the project will prove sustainable beyond the life of the donation, particularly if your request partly covers costsOther fundingPlease detail all other sources of funding for the projectMonitoringHow do you plan to manage and monitor the effective use of the donation?Measuring successWhat measures of success will you use, and how do you propose to measure success?Contact DetailsYour Communications/PR contact namePlease only complete if this is different from the contact name given aboveTelephoneEmailAttachmentsCharity’s latest audited financial accountsI have included a copy of our charity’s latest audited financial accounts with my application.Please include a copy of your latest audited financial account with your application, and confirm here that you have attached themI have read and agreed to the Terms and Conditions. I have attached our latest audited financial accounts___________________________________________________ [signature]___________________________________________________ [position held at the charity]Signed for and on behalf of the Charity named on this application form ................
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