Trefoil Holiday Grant

LILIAS FINLAY HOLIDAY FUND

SECTION 1

Name and contact details of Applicant seeking grant funding e.g. name of child or young person. If you are completing this application on behalf of someone else please see Section 7.

Applicant

First NameLast Name

Date of birth

DayMonthYear

Address

Street Address

Street Address Line 2

City

Post Code

Is this address the normal place of residence

Phone Number

Area CodePhone Number

Phone Number*

E-mail*

SECTION 2

Details of Applicant’s Condition or Disability

Details of medically diagnosed condition or disability:*

Date when disability was diagnosed:*

List of special needs, equipment or support that the applicant is dependant on:*

Cost of meeting the special needs, equipment, support,etc:*

Are you known to your local Social Services Department or do you consider yourself to be disabled?*

SECTION 3

Planned holiday details and funding request

Dates of holiday*

Destination*

Who will be accompanying the applicant on the trip? (i.e. parents, siblings, etc.)*

Name of travel company

Details of any payment made or deposit to be paid

Total cost of holiday

List of special needs that must be met for the applicant to participate in the holiday*

Cost of meeting these needs*

How much grant funding is being sought on this occasion*

Upload booking form or quotation for your holiday. If you are using a mobile device and are unable to upload a file, please email your quote to trefoil@wssociety.co.uk

Browse Files

SECTION 4

Previous Applications

Have you applied to Trefoil for previous funding?*

If Yes, please supply dates and amount of funding granted:

Has an earlier grant application been refused?

SECTION 5

Supporting Letters

The Trustees will consider at least two of the following documents, which should be dated within the last 12 months, as support for an application:

Letters or emails written by a professional involved with the applicant’s care or wellbeing (e.g. doctors, nurses, teachers, support workers, social workers).
Child/Adult Disability Payment award letter.
Various DWP assessment reports.
Medical appointment letters.
Medical overview letters (issued by GPs).
Medical referral letters.

If this is not possible please send the letters to Trefoil, The Signet Library, Parliament Square, Edinburgh, EH1 1RF or ask your referees to email trefoil@wssociety.co.uk

References must be received in advance of the stated deadlines or applications will not be considered.

Upload TWO (2) supporting letters. Your application cannot be considered without references. If you are using a mobile device and are unable to upload your files, please email your references to trefoil@wssociety.co.uk

Browse Files

Upload Referees supporting letters (2). If you are using a mobile device and are unable to upload your files, please email your references to trefoil@wssociety.co.uk

SECTION 6

Statement of application for grant funding

This section confirms the true and accurate nature of the details supplied above. The Applicant must tick his understanding to this effect. If the applicant is unable to complete this application form and it has been completed on their behalf then this person should complete Section 7 below.

I understand

SECTION 7

Details of Person completing the application form on behalf of the Applicant

Name

First NameLast Name

Address

Street Address

Street Address Line 2

City

Postal / Zip Code

Phone number

Relationship

If the applicant is under the care of a parent, guardian or power of attorney and you are not this person, then state their name, address and contact telephone number and relationship details.

How did the applicant hear about Trefoil?*

SECTION 8

Declaration

The information you provide in this application form will be held and processed in accordance with the Data Protection Act 1998 and the EU General Data Protection Regulation (GDPR), and will be used by Trefoil to carry out grant processing, analysis, auditing, accounting and evaluation. The information on this form will not be used for any other purpose nor will it be published on our website, and we will not discuss the information on the form with any other agencies or organisations.

I hereby apply for a grant from Trefoil for the young person and for the purpose as stated above and declare that to the best of my knowledge and belief the above information is true and accurate. I consent to the information being shared among the Trustees.

Signee*

First NameLast Name

Date*

Date