DHSA GRANT APPLICATION FORM

Date of Application:
Title:
First Name(s):
Surname:
Maiden Name:
Address:
 
Town:
County:
Postcode:
Country:
Telephone:
Email Address:
Date left school:

Title of proposed course / activity grant required for:
Approximate date/duration of course/activity:
Total cost to be raised by applicant:
Other sources of funding:
Location of course/activity:
Description of course/activity:
Reason for undertaking course/activity (e.g. perceived professional/personal benefits):
Reason for grant application:
Any other relevant information:

In submitting this application, I agree to the following terms and conditions:

I will submit a grant report within 3 months of completing the project. If for any reason the project is postponed/cancelled within a year of grant funding, I will return the funds to the DHSA. I understand that this application will be considered at the meeting following the appropriate January/April/September deadline, according to the timing of submission. The DHSA has the right to use all application/report information for marketing purposes.


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