Grant application and assessment form  
Ms People Caithness
Applicants/carers/family member should complete sections 1 and 2 and post this form to Sgeir mhaol, Newton Hill, Wick, Caithness KW1 5SB


1. Name…………………………………………………………………………..

Address…………………………………………………………………………

Phone number…………………………………………………………………..

E mail address…………………………………………………………………..

Details of carer (name, contact information)
If applicable.



2. Details of request for grant ie purpose to which monies will be put.  How much is being requested?  

……………………………………………………………………………………..

………………………………………………………………………………………

……………………………………………………………………………………….

………………………………………………………………………………………..

………………………………………………………………………………………... 

Signature of applicant or carer ……………………………………………………….


                                           For Official Use.
Are other funds necessary to achieve purpose?    Signpost to other funding sources. 
If appropriate consider conditional approval.

Application approved/granted conditionally/declined by ………………………

 Date………………..

Print name………………………………………………………………………………

Application approved/granted conditionally/ declined by …………………………………………………….. Date…………………

Print name ……………………………………………………………………………..

Details of any conditional decision:…………………………………………………….

…………………………………………………………………………………………..


Is payment to be made direct to applicant/supplier?     (delete as appropriate)

Payment made Date……………………………………………………………