Application Form


 c/o 66 Devonshire Road, Cambridge, CB1 2BL.

This Form is ONLY for completion by referring organisations – not by the applicants for grants themselves. Leaving out any information may cause delays. We are unable to help with Rent and Mortgage payments, Catalogue and Credit Card Debts, Loans, or Court costs and fines.

Name of applicant:                                                             Age:


Partner’s Name:

Children in family & ages:

It is helpful to know figures if possible about the following:-

Earnings per week:

Benefits per week:

Outstanding Debts (e.g. Utilities):

Name, address (in CAPITALS please), phone number and e-mail address (if available) of Sponsoring Organisation/Person:




General background report on need (or attach on separate sheet) -keep it short but give us enough!








Please specify approximate cost of item or grant required (do be specific if you can!):

To whom cheque(s) should be made payable:

(NB:cheques are payable to the sponsoring organisation, or to the shop/service provider – NOT to the applicant/client)

Have you considered whether the Cambridgeshire Local Assistance Scheme can make a grant (see website link) ?

Have you applied to any other Charities?



It is helpful for information needed by certain of our funders if we can analyse the overall profile of ethnicity of those who benefit from our grants.

Applicant’s ethnicity? ……………………………………e.g. White ( British or Irish or East European or Travellers or Other). Mixed ( Black Caribbean and White or Black African and White or Asian and White or Other). Asian or Asian British (Indian or Pakistani or Bangladeshi or Other). Black or Black British (Caribbean or African or Other). Chinese or any other.