Grant Application Received Form

An application for a Grant has been received by the Trustees of these Charities

From:
Address
Street Address Address Line 2 City ZIP / Postal Code

and your name has been given as a referee. I should therefore be obliged if you would please answer the questions set out below and submit the form.
STRICTLY CONFIDENTIAL
How long have you known the applicant?
In what connection do you know the applicant?
Is the applicant a person of good character?
How long has the applicant resided in the Ancient Parish of Handsworth to your knowledge?
As far as you know what are the applicant’s means?
Can the applicant reasonably expect assistance from relatives or others?
Is the applicant unable to maintain himself/herself for the reasons of accident, ill health or infirmity?
Has the applicant shown reasonable providence?
Please give any other relevant information.
Date
MM slash DD slash YYYY
Signature
Address
Street Address Address Line 2 City ZIP / Postal Code
Email
Telephone Number

STRICTLY CONFIDENTIAL