Speen Shop Charities Application Form





Please complete this form if you or your club or society would like to apply for money from the Speen Shop Charities Committee.The form cannot be submitted electronically – please print off, complete and follow instructions at the bottom of this page.


Terms of Reference


·The Speen Shop Charity will provide financial assistance for any useful non-commercial purpose, which either satisfies an individual need, or is of benefit to the community.


·The scope of the Charity is restricted to the Parish of Speen.


·There must be a clear and demonstrable educational, medical, social or community need.


·As a general rule, funding should not be available from an alternative source.


·The provision of a grant should directly benefit a local individual or group, or the village in general.



If you want to discuss your application before submitting it, please contact one of the Committee members:-


Peter King (Chairman)      Tim Crossley

Sarah Bowen                   Roger Craft                        

Trish Preston-Whyte         Keith Dobson/Rosemary Pickworth (Bucks Housing Association)


The Speen Shop Charities Committee meets four times a year (in early March, June, September & December).Your claim should be received by the third week of the preceding month and will be considered at the meeting following its receipt.You will be notified in writing of the outcome.Please seal your completed form in an envelope addressed to Peter King and deliver to 11 Abbotswood, Speen, email peter.king@360-search.com or post to Rosemary Pickworth at The Buckinghamshire Housing Association Ltd., Unit 4 Stokenchurch Business Park, Ibstone Road, Stokenchurch, High Wycombe, BucksHP14 3FE email rosemary@bucksha.co.uk



Please supply the following information:- (you will need to use a separate sheet.)





Your name:










Your address:







Tel no (daytime):Tel no (evening):







For whom or what is the grant required?:













How much is needed?



Name, address and phone no. of your G.P., social worker or O.T. (if relevant to your application)







Other potential sources of funds (including any funds available from your own reserves)







Please explain in detail what the money would be used for:









































I confirm that the information given is correct to the best of my knowledge and I agree that any reasonable further investigations may be undertaken to validate this claim.


Signed:                                                                                                              Date:




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