Thurrock Smokefree Community Grant copy - Application Form

Default Section

Organisation details

Project details

Banking Details and Declaration

Choose a language

You have missed the deadline for this form

Smoke Free Awareness and Signposting Grant Funding Aims

Organisation

Organisation Name

Organisation address

Organisation email address

Organisation phone number

Please give brief background information about your organisation, the services that you provide and the people you support

0 / 250 words

Contact information

Name of contact

Contact's email address

Project details

Which of the following groups are you able to impact to reduce smoking rates in Thurrock

• Routine and Manual workers• Asian, black and mixed-race people• People with long-term mental health conditions• Adults with substance misuse• Pregnant people

Which areas of Thurrock are you able to impact?

Select a value

Aveley

Chadwell St Mary

Grays

South Ockendon

South Stifford

Tilbury

West Thurrock

Other, please specify below

Project Title

Project Description

0 / 500 words

Number of sessions / events where smokefree messaging will be incorporated over the project period

Describe the type of sessions / events you will be delivering as part of this project

Select a value

Appointments (1 to 1)

Community groups

Drop in sessions

Training

Workshops

Other, please specify

Number of people you expect to impact within the length of the project

Will you need to recruit new staff or volunteers for this project?

Number of Staff delivering the project

Number of Volunteers delivering the project

Budget breakdown

0 words

Bank Account details

Bank account name

Bank Account Number

Bank Sort Code

Name of Bank

Declaration

Please confirm you agree to the following: