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APPLY FOR A GRANT FROM DCCF

IMPORTANT: The application process will be open from the 1st of June 2022.

Please note that any information you give us will be stored subject to and compliant with the UK Data Protection Act 2018 intended to protect your privacy. This means it will only be used in accordance with our Privacy Policy which can be viewed on our website.

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

Surname*
Forename
Date of birth (dd/mm/yyyy)*
DD slash MM slash YYYY
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?*
£ Amount required (estimated if not known)*
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 to help the Charity by sharing your story.
- Yes
- No
I give DCCF my Explicit Consent to store and process the information given here in compliance with the UK Data Protection Act 2018 and our Privacy Policy in order for my application to be processed.*
- I give DCCF my Explicit Consent to store and process the information given here in compliance with the UK Data Protection Act 2018 and our Privacy Policy in order for my application to be processed.
Signed (please give full name)*
Date (dd/mm/yyyy)*
DD slash MM slash YYYY
How did you hear of DCCF?
Postal address: DCCF, ‘The Factory’, 14 Alder Hills, Poole, BH12 4AS
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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

Postal address: DCCF, ‘The Factory’, 14 Alder Hills, Poole, BH12 4AS

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