Grant Application Form

To apply for a Barts Guild grant, please complete this form and when ready click the ‘SUBMIT’ button once. You can attach up to three documents in support of your application.

PLEASE NOTE that the form cannot be saved and returned to at a later date; therefore it must be completed and submitted in one session.

* indicates a mandatory field

ABOUT YOU

 
Title*

Given Name*

Family Name*

Job Title*

Department*

Work Address*

Tel. (work)*

Tel. (mobile)

Email address*

 

YOUR APPLICATION

 
Grant Title*

Please explain what this grant will be used for.*

What will be the impact of this grant for the Hospital and its patients?*

Amount Requested:*

Does this include VAT?*
YesNoNot Applicable

Is this the full cost of the item/service?*
YesNo

Does this grant relate to an item or items that will require on-going maintenance and/or consumables?*
YesNo

If applicable, has authorisation been given to submit this application by a senior, eg line manager, ward manager, supervisor, etc?* Please refer to the Grant Policy for when this might be necessary.
YesNoNot Applicable

If you would like to attach any documentation in support of your application, please do so using the buttons below. You can attach up to three documents.



Finally, if there is any additional information in support of the application, such as a website link to a product/service, please provide those details here.