Grant Funding Application

Full Name: (required)

Address: (required)

Phone Number: (required)

Email: (required)

Are you a member of Spinal Injuries Scotland? If not a member, please be aware you will need to be a member in order to apply for this Grant. (required)

YesNo

Requesting Equipment - Tell us about the equipment you are requesting and why you need it.

Give us a description of the equipment that you are requesting. (required)

What is the total cost of equipment? (required)

What is the amount sought from the Grant? (required)

How do you plan on paying the remaining balance? (SIS will contribute up to 50% towards items with a plan to pay balance)? (required)

If you are receiving grant funding from another source, are there any restrictions? (required)

Can you provide details of the supplier and other relevant details? (required)

What is your reason for your request (use 500 words)? (required)

What difference would this make to your life, in terms of independence and wellbeing? (use 500 words)? (required)

Send