Your responses to all questions on the form are displayed below. Please check them carefully before submission. If you wish you can print a copy of the form using the button above. You can revise the form at this point by clicking on Revise at the bottom of this screen.

Click Complete at the bottom of the screen to submit your application for assessment.

When you click Complete at the bottom of this screen you will receive a confirmatory email, with a copy of your completed form attached, at the email address specified in your answer to question A3 (see below). You will not be able to amend the form once you have clicked Complete.


A1 *Organisation Name
A2 Organisation Address *Address 1:      
  Address 2:    
  Address 3:    
Telephone Number
A3 *Name of Contact Person
Contact Telephone Number
*Contact Email Address
Contact Address (if not as above) Address1:      
  Please leave blank if using Applicant address details Address2:    
A4 *What is your position in your organisation?
A5 *What is the legal status of your organisation?
A6 If Registered Charity, please give your charity number
A7 If Registered Company, please give your company number
A8 *In what year was your organisation founded?
A9 *Briefly describe the aims, objectives and activities of your organisation
(Maximum 1000 characters)
B1 *Who will be the main beneficiaries of the grant?
Will this be for a single individual, a family, a group holiday etc (Maximum 1500 characters)
B2 *Please provide information about the disadvantage affecting the beneficiary/beneficiaries
Economic, disability etc (maximum 1500 characters)
B3 When will the holiday take place?      
*Start Date
*Finish Date
B4 *Where will the holiday take place?
The Trustees do not fund holidays overseas (maximum 1000 characters)
B5 *What type of holiday will this be?
Activity/respite/family etc (maximum 1500 characters)
B6 *Who will be running the holiday and providing any activities that take place?
Your organisation/outside providers/not applicable (maximum 1500 characters)
B7 *Please confirm that all necessary Disclosure and Barring Service (DBS) checks have been made on staff/volunteers
B8 *Please confirm your compliance with the Data Protection Act 1998
B9 *Please confirm that any grant awarded will be for the benefit of those residing in the West Midlands or Greater London area. Please select as appropriate.
If the beneficiaries will not be from either of the two areas shown then you are not eligible to apply for this funding.
C1 *How much will the holiday cost per person?
Enter amount to two decimal places
C2 *Total cost of the holiday
Enter amount to two decimal places
C3 *Amount raised so far
Enter amount to two decimal places
C4 *Deficit to be raised
Enter amount to two decimal places
C5 *Total amount requested from the Trust
C6 *Grants for holiday funding are generally below £1,000 and may not meet the full cost of a holiday. How will any shortfall be provided for?
(Maximum 1200 characters)
C7 *Please give the account name which should appear on the cheque if you are successful
Cheques can only be made payable to registered charities. If you are not a registered charity please click ? for further information.
Signed Annual Accounts
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