Please make sure that you have read the community support criteria fully, before submitting an application and complete all sections.

Section 1 - Information about the Organisation

Name of Organisation requesting support

Charity Registration Number (If Applicable)

Website (If Applicable)

Name of the main contact for this application

Address

Telephone Number

Email Address

Section 2 - Information about the organisation requesting support

Please provide an outline of the organisation requesting support, including its objectives, recent achievements and target beneficiaries.

From the organisation's most recent set of annual accounts, please fill out the information below:

Total income received

Total amount of expenditure

Total amount carried forward

Total amount of unrestricted funds

Section 3 - Information about the service being requested

The following section requests information relating to the need for the support from the Bursary Fund that you are requesting. Please provide as much information as possible within this form and refer to the Community Support Criteria carefully before answering these questions.

What are the main needs of your organisation at the present time?

Which programmes do you wish to apply to the bursary fund for? (please list dates)

Who, and how many people, will benefit from the support?

What difference will this support make to the community, and in particular to those people aged under 18?

How does this application meet our criteria of ‘making a little money make a big difference?

Which local government (District council) area of Norfolk will most benefit from this project?

Please give details of someone who could we contact as an independent referee for your application. (This should be someone outside of your organisation who could speak about the work of your organisation)

Full Name

Relationship to the Applicant

Telephone Number

Email Address

Section 4 - Declarations

Before submitting this request, please check all the statements carefully. By applying for this community support, you agree to the following declarations.

  • All the information given in this application are correct to the best of my knowledge
  • I am authorised to act on behalf of the individual/organisation that may benefit from any support awarded
  • I have read and understood the community support criteria
  • I understand that if this project does not go ahead, or the individual or organisation applying for the support, is in breach of the community support criteria, that The Trustees of the Kearns Foundation reserve the right to demand repayment of all, or part of the support made.
  • I undertake to acknowledge The Kearns Foundation for any support awarded in publicity relating to this project.
  • I understand that if support is awarded I will need to supply copies of accounts and bank statements
  • I undertake to provide The Kearns Foundation with a short report on completion of this project/purchase or within 12 months of the support award, whichever occurs first.