Name of Group*Contact Name*Contact Address* Street Address Address Line 2 Town / City County Postcode Contact Phone Number*Contact e-mail Address* What type of organisation are you?* Voluntary Organisation Community Group Community Interest Company (CIC) Social Enterprise Co-operative Charity Other If other, please specify*How many people are on your committee?*Does your group have a constitution or set of rules?*YesNoDoes your group have a bank account?*YesNoBank Account Name*Sort Code*Bank Account Number*What do you want to do?*How much money do you need? (max £1,000) Please list each item separately*Which PROSPECTS’ Theme does the project fit under?* Biodiversity Sustainable Transport Local Food Waste & Recycling Energy Environmental Awareness Where will the project take place?* Accrington Altham Baxenden Church Clayton-le–Moors Great Harwood Huncoat Oswaldtwistle Rishton Hyndburn – Wide When will the project take place?*How many people will benefit from your project?*0-1011-2526-5050+Are you attaching any supporting information?*YesNoPlease tick if you are happy to be added to The PROSPECTS Foundation newsletter email list and receive the monthly Events Bulletin, regular updates about activities, courses and training events and information about current and future projects.*YesNoDate Date Format: MM slash DD slash YYYY Δ
