Gynaecological Cancer Society
GRANT-IN-AID APPLICATION FORM
APPLICANT'S NAME :
OCCUPATION :
CURRENT POSITION / INSTITUTION :
CONTACT PHONE NUMBERS :
Work _______________________
After hours _______________________
HOW YOU WILL USE THE GRANT :
HOW THIS WILL BENEFIT YOUR GYNAECOLOGICAL CANCER RELATED ABILITIES & ACTIVITIES :
WHAT IS THE VALUE OF THE GRANT YOU ARE SEEKING :
(Maximum Grant $ 1,000) $ ____________________
HOW THE GRANT WILL BE USED :
Travel $ ____________________
Accommodation $ ____________________
Fees $ ____________________
Other $ ____________________
TOTAL $ ____________________
HAVE YOU BEEN GRANTED ATTENDANCE LEAVE BY YOUR EMPLOYER? YES / NO
(Please attach confirmation letter from your employer)
PLEASE NOTE THE FOLLOWING :
- Applications for this grant round close
- Applicants may apply for a grant for more than one purpose at a time
- The decision of the judging panel is final
- If your application is successful and you do not complete the grant purpose, use the funds in full, or in the intended manner, you will be
required to refund the grant in part or in full.
APPLICANT SIGNATURE ___________________________ _________ DATE _______________
PLEASE RETURN THE COMPLETED APPLICATION FORM PLUS ATTACHMENTS BEFORE THE CLOSING DATE TO:
MR JOHN GOWER
CHIEF EXECUTIVE
GYNAECOLOGICAL CANCER SOCIETY
100 KILKIVAN AVENUE, KENMORE, QLD, 4069
Contact details:
