Application Form

Careful and complete application forms help us all to be more efficient. Your efforts will be much appreciated by our hardworking volunteers.

    1. Details of Children in Application

    Child's / Group's Name* Age* Sex*

    2. Home Details

    3. Purpose of Grant

    BEFORE COMPLETING THIS SECTION PLEASE READ OUR GUIDANCE NOTES

    Please fill in the amount requested in the appropriate category below and add the total.

    • For multiple items, please provide itemised costings in Section 5.
    Items Requested Amount £
    Bed / Bedding / Mattress
    Bedroom Furniture / Flooring
    Clothing / Footwear
    Tutoring / Education
    Club / Activity
    School Trip
    Respite
    Transport
    Special Needs Equipment
    *** Other
    TOTAL*

    *** If other is selected please add details:

    4. Supporting Information*

    Please supply information to support this application,

    • Including a summary of family circumstances with some reference to why there is a financial need. Please indicate in the box below any financial benefits that apply to the applicant (eg Universal Credit, Income Support, Income-based Job Seeker's Allowance, support under Part VI of the Immigration and Asylum Act 1999, Scottish Child Payments)
    • A summary of any relevant medical information but no copies of medical documents (to protect privacy)
    • Full details regarding the specific purpose of the grant and the difference it will make to the quality of life of the individual(s)

    5. Itemised Costings*

    Please include hyperlinks/quotes for items required
    (Quotes will be required BEFORE YOU APPLY for all BCC payments which are to be paid direct to suppliers, eg. from Playarama or Chrysties in Hawick or any other direct supplier. Applications for most other major items (excluding clothing) must contain the Hyperlink(s) to the product with the item/s identified and costed.)

    6. Details of the Organisation Making Application

    7. Payment Details

    Please provide exact name as it appears on bank account, sort code and account no. (Note: we no longer make payments via cheque)

    DECLARATION BY THIRD PARTY

    In making the application, I declare that I will be responsible for ensuring that:

    1. Any grant awarded is used for the purpose for which it is given.
    2. I will confirm receipt of any funds.
    3. I will return all money not spent to Borders Children’s Charity so that it may be spent on future applications.
    4. I confirm that this application form has been completed with the full knowledge of the adult with parental responsibility for the child or children in this application. I further confirm that they have been made aware of the privacy notice which explains how the child or children’s personal data will be processed by Borders Children’s Charity.

    I understand that failure to do so may result in future requests being unsuccessful.

    SUBMITTING THIS FORM

    1. Please check that all sections of the application form are completed, as incomplete applications will not be considered.
    2. By submitting this form both the agency representative and the grant beneficiary agree to the information on the form (and on any attachments e.g. supporting letters) being retained in the BCC filing system for up to 7 years.
    3. By submitting this form both the agency representative and the grant beneficiary commit to spending any grant awarded on the items stated on this form only. Failure to comply with this may result in future applications being rejected.
    4. This form has been completed with the knowledge of the adult with the parental responsibility for the beneficiaries. I have made them aware of BCC's GDPR policy.