Help for Health logo

 

Improving the health and well-being
of people living in East Yorkshire
and Northern Lincolnshire

 

Please complete our standard application form. It is essential that the applicant makes quite clear which of the objects below is fulfilled.

Our Objectives

  • the provision of medical and hospital treatment and care not replacing any statutory obligation of government;
  • the provision of medical and hospital facilities, equipment and/or provisions not replacing any statutory obligation of government;
  • the provision of grants and assistance to the sick, mentally or physically disabled and their respective relatives, dependents and/or carers;
  • the provision of grants for medical research, medical education and medically related projects;
  • the provision of grants to benefit people living within our geographic area e.g. East Yorkshire and Northern Lincolnshire;
 

Find out more about application requirements and the adjudication process


Research applicants must complete all sections

Please be aware that the application process does not offer a save function for incomplete submissions.


PERSONAL DETAILS


Title

Forenames (in full):

Surname

Organisation (if applicable):

Position Within Organisation

 

Address line 1

Address line 2

Address line 3

City

Region

Post Code

 

Tel No. (inc STD code):

Day-time Tel No. (inc STD code):

Email address:

Fax number (including STD code):


JUSTIFICATION FOR SUPPORT REQUIRED


Summarise below the purpose of your application including the object(s) of the Trust which it fulfils:


RESEARCH APPLICATIONS ONLY


Research applications only (Please complete the following):

A simple description of the proposed research using clear lay terminology, which should be readily understandable to members of the general public.

This should include the following:

Details of the disease/condition and any associated conditions i.e. who suffers, the symptoms and numbers affected.

How research might help those sufferers in the short/long term.


FINANCIAL


Financial Details:

(to be completed by all applicants)

Financial details of the grant including amount of monies required, details of proposed usage of monies and estimated time of support:

Total £


Details of other financial support already obtained or applied for:

(NHS Trust applicants are asked to state whether they have applied to their respective Charitable Funds and the outcome)


Supporting Documents


Please upload any supporting documents for your application:

Upload image files .jpeg & .png, PDF, Word .doc, Excel .xls and plain text .txt


DECLARATION


If my application is successful I agree (a) to submit reports to the Trust on the use of the funds, as requested by the Trustees when the award is made and (b) to the publication of the award on the Trust’s web-site and such other promotion of the award as the Trustees reasonably require.

Please tick this box to confirm you are authorised to submit this application on behalf of your organisation.