Application form HEALTHWATCH OFFICIAL USE ONLY Date application Grant application received number Office signature Approved GRANT APPLICATION Name of organisation Company limited by guarantee □ Unincorporated □ Registered charity Charitable trust Type of organisation □ □ Charitable incorporated Community Interest Company (please tick whichever applies) □ □ organisation (CIO) (CIC) Registered charity number if applicable CONTACT DETAILS Organisation Address: Contact name: Email: Contact phone Website: number(s): / A What would you like to do? Date and time you would like to hold the activity/event Address where activity / event will take place Which main category your project falls into: Start Well, Live Well, Age Well
Application form HEALTHWATCH OFFICIAL USE ONLY Date application received Grant application number Office signature Approved GRANT APPLICATION Name of organisation Type of organisation (please tick whichever applies) □ Unincorporated □ Registered charity □ Charitable incorporated organisation (CIO) □ Company limited by guarantee □ Charitable trust □ Community Interest Company (CIC) Registered charity number if applicable CONTACT DETAILS Organisation Address: Contact name: Email: Contact phone number(s): Website: / What would you like to do? Date and time you would like to hold the activity/event Address where activity / event will take place Which main category your project falls into: Start Well, Live Well, Age Well A
Grassroots%20Application%20Form%202018%20phase%202.docx