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APPLY FOR A GRANT FROM DCCF

Please note that any information you give us will be stored subject to and compliant with the new GDPR (General Data Protection Regulations) intended to protect your privacy. This means it will be:

Stored securely.
Current – we do not store historic data unless we are obliged to do so under other regulations.
Only used in ways to which you expressly give consent.
Will not be passed on to anyone without your permission, even within the charity.

If you would rather download and print the form, please download the PDF version

**Please complete the fields below (obligatory fields marked *):**

Surname*
Forename
Date of birth*
Gender*
Address Line 1*
Address Line 2
Town*
Postcode*
Preferred email Address*
Preferred telephone number(s)*
Name of GP*
Nature of illness*
To support your application please also provide, in your own words, the following information
Details, costs and why to be awarded?*
I give permission for the following to contact me*
- DCCF Trustees and Administration
- DCCF Public Relations Officer (see below)
- I would like to receive the e-newsletter
DCCF relies heavily on our beneficiaries to spread the word about what we do. If you would agree to our press team contacting you at a later date to report on your story, we would be extremely grateful. Please signify your willingness here: I am/am not happy to help the charity by sharing my DCCF story.
- Yes
- No
I give DCCF permission to store the information given here in compliance with GDPR*
- I give DCCF permission to store the information given here in compliance with GDPR
Signed (please give full name)*
Date*
How did you hear of DCCF?
NB. WE WILL NOT STORE PERSONAL DATA AFTER MAY 2018 WITHOUT UPDATED CONSENT UNLESS OBLIGED TO DO SO BY LAW

Postal address: DCCF, Slipway, 36 Dorset Lake Avenue, Poole BH14 8JD
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HERE TO GIVE FINANCIAL HELP TO DORSET RESIDENTS AFFECTED BY CANCER AND THEIR FAMIILIES

APPLY FOR A GRANT FROM DCCF

Please complete the fields below (obligatory fields marked *):

To support your application please also provide, in your own words, the following information

NB. WE WILL NOT STORE PERSONAL DATA AFTER MAY 2018 WITHOUT UPDATED CONSENT UNLESS OBLIGED TO DO SO BY LAW

Postal address: DCCF, Slipway, 36 Dorset Lake Avenue, Poole BH14 8JD

**Please complete the fields below (obligatory fields marked *):**