Equaliser Confirmation of Expenditure

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Equaliser Confirmation of Expenditure

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Equaliser Fund aims to level the playing field for participants, by providing small one-off grants that remove an immediate barrier preventing them moving forward with an activity, learning or employment.

Referrer Information

Mentor
Programme
Date of Application

Type of Grant requested

Active Fund	Learning Fund	Employment Fund
Household Support Essentials Fund

Participant Ref. Number*

0

Title*

First Name*

Forename is required

Middle Name

Text 3 is required

Surname (s)*

Surname is required

Like to be known as

Greeting is required

Gender*

Male

Female

Prefer not to say

Non Binary

Date of Birth*

Date Of Birth is invalid, use the following format dd-mmm-yyyy

Age

Age

Participant Address*

Postcode:

Building Name:

Secondary Name:

Street:

District:

Town:

County:

Email Address

Email is required

Mobile Phone*

Mobile is required

THG Tenant

Yes No

Referrer to tick to confirm they have been clear with the participant; this is an application process & the funding is not guaranteed. It needs to be checked by an independent person. *

Approved*

Yes No

Reasons

Attach receipt:

Attach Expenditure Receipts