Application for a Grant

Please give full details of the person for whom the grant is required.
If you are making this application on behalf of the person above, please give your details here, otherwise please skip this step.
Are you applying for independent accommodation in Staffordshire?
Please provide any further information which may assist us in reviewing your application. Please note that your application will be delayed if you do not provide detailed and accurate information.

A reference from your Housing Association or Organisation recommending your application should be included

You must provide at least 2 written quotations.
Please type your full name here as a digital signature of this form
  1. If preferred, you can download this form and can complete it digitally. Once completed, you should save it and then send it as an attachment to:
  2. Alternatively, the form can be printed out and completed manually. Please send to: PA to Chief Executive, Stafford & Cannock League of Hospital Friends, Caxton House, North Walls, Stafford     ST16 3AD
  1. Approval is required from both Rotary Clubs in Stafford & Cannock and League of Friends
  1. You need to include the following when applying for a grant:
  • This completed Application Form
  • Reference from Housing Association or Organisation
  • Two written quotations