The Hastings Cancer Trust Grants Program

Name of your organisation

Mailing address of your organisation

Full name and title of the primary contact

Preferred email address of the primary contact

Preffered contact phone number for the primary contact

Full name and title of the secondary contact

Preferred email address for the secondary contact

Preffered phone number for the secondary contact

Is the project based n the Hastings, Camden Haven or Macleay area?
Yes No Not Sure

If you answered Not Sure to the above question please provide details why

Is the project cancer related?
Yes No Not Sure

If you answered Not Sure to the above question please provide details why

Will the project be commenced within the next 12 months
Yes No Not Sure

If you answered not sure to the above questions please advise when you expect the project to commence

Please provide the details of the project

What are the key objectives you wish to achieve from the project

What need(s) will be filled through the implementation of this project

Who will benefit directly and indirectly from the project

How will the project continue to provide benefits into the future

What is the estimated total cost of the project

What is the amount you are seeking from the Trust to help fund this project

If you are seeking co-funding from another provider please state the name of the provider and the amount of funding being requested

Please attach invoices and quotations to substantiate your request

Please add any additional information relating to the project that you consider relevant for a fuller understanding of your request.

Signature

Thank you.