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 a 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?


Cambridge Central Aid Society (CCAS)
Privacy Notice for Potential Grant Beneficiaries

CCAS uses personal data about potential grant beneficiaries to determine whether to award a grant to help relieve social distress or financial difficulty.

CCAS is committed to its legal and ethical responsibilities to handle personal data securely and not share it with any other organisation without the explicit permission of the individual.

Personal information in any application form is retained for 18 months and then destroyed. This is to allow CCAS to a) check whether it has given a grant to the individual within the last 12 months, without there being any change of circumstances and b) to provide evidence for any audit or independent examination that CCAS’ most recent annual financial statement is soundly based.

I confirm I have my client’s permission to pass their personal and sensitive data to Cambridge Central Aid Society in order for them to consider making a grant to my client

May 2018