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If you are applying for a research grant please submit your application as stated in the Research application guidelines

Please complete this form clearly. All sections must be completed. Ensure that you have all the information required to hand. You must complete the application in full before submitting the form as there is currently no option to save progress and return to the form later. All data will be lost if you exit the application without submitting the form.

Answers in excess of the number of words stipulated in sections 6, 7 and 9 will be edited.

Please read the Terms and Conditions and the Privacy Policy before completing the form.

1. Name and Address of Applicant

Reference number

Title

First Name

Last Name

Job Title/Office

Address 1

Address 2

Town

County

Postcode

Country

Telephone

Fax

Charity name

2. Name and Address of Organisation

You only need to fill in your organisation address if it is different from question 1

Organisation

Address 1

Address 2

Town

County

Postcode

Country

Telephone

Fax

3. What is the address for correspondence 1. Name and Address of Applicant2. Name and Address of Organisation

4. Charity Registration Status

Is the Organisation a Registered Charity

Other comments

5,6,7. Project details

5. Title of the project for which funding is being requested

6. Principal Activities of the Organisation (no more than 50 words)

Word count: 0 words

7. Description of the Project including the number of individuals with learning disabilities who will benefit from the project (no more than 80 words)

Word count: 0 words

8. Costings

a) Expenditure

What is the total cost of the project

Detail how this figure is arrived at.

b) Income

How much money, if any, have you already raised for this project?

From what sources has this income been gained

c) Statutory Service Funding

Is the project receiving financial support from the statutory services?

If yes, give details

If no, have you established whether the project is eligible for such support?

Please give details

9. Grant-aid requested from the
Baily Thomas Charitable Fund

Please state the amount being requested

Specific purpose (no more than 30 words) for which it is required

Word count: 0 words

Should a grant be awarded, please state the exact name of the organisation in whose favour it should be drawn. It is extremely important that the correct name is stated.

10. Referees

Names and addresses of two independant referees familiar with the applicant or project, but not directly associated with the organisation:

Referee 1

First Name

Last Name

Address 1

Address 2

Town

County

Postcode

Country

Referee 2

First Name

Last Name

Address 1

Address 2

Town

County

Postcode

Country

11. Undertaking

If the application is successful, I/We undertake:

To submit a report on the project within 3 months, or such time as is stated in the grant offer letter, of the completion of the project (and agree to this being used by the Baily Thomas Charitable Fund in any way the Trustees so decide).
To return to the Baily Thomas Charitable Fund any money not used for the stated purpose.
To agree if requested, to a visit to the project by a Trustee or Assessor of the Baily Thomas Charitable Fund.

I agree to the above statement

12. Declaration by grant applicant for funding to
place individuals with learning disabilities at
third party places of employment

I acknowledge in connection with the Application for a grant from the Baily Thomas Charitable Fund for the purpose of placing an individual or individuals with learning disability(s) that it is our responsibility to take all necessary steps for securing the health, safety and welfare of all such individuals to the same extent and in the same manner as an employer is required to do in relation to employees by or under the relevant legislation, including any associated approved codes of practice, for the time being in force.

Health and safety at work application form

13. Terms & Conditions and Privacy Policy I have read and agree to the Terms & Conditions and the Privacy Policy.

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