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Dance Fund Application

Step 1 of 8 - 1. Initial information

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1. Initial information
Have you applied anywhere else concerning this request?*
- Yes
- No
Please say where and date you expect to hear if you have been successful?
Where did you hear about the Dance Professionals Fund?
- Word of mouth
- Newsletter
- Online search
- Turn2us
- Social media
- Other
Please specify

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2. Personal details
First Name*
Last Name*
Date of Birth
Date Format: DD slash MM slash YYYY
NI Number
Contact Number
Email Address*
Address
Town
County
Postcode
Country
Do you have a disability?
- Yes
- No
Employment Status
- Employed
- Self-employed
- Unemployed
- On Sick Leave
- Retired
- Other
Please specify

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3. Personal circumstances
Do you live with a partner?
- Yes
- No
Partner’s Occupation
Partner’s Employment Status
- Employed
- Unemployed
- On Sick Leave
- Retired
- Other
Please specify
Do you have children under 18?
- Yes
- No
Number of children under 18
Ages of children under 18
Do they live with you?
- Yes
- No
Housing Status
- Private Tenant
- Social Tenant
- Owner (with mortgage)
- Owner (without mortgage)
- Shared ownership
- Living with parents
- Other
If other please specify

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4. Income
Income (net) £
Average post tax earnings
£/Month
Working tax credits
£/Month
Child Benefit
£/Month
Child Tax Credit
£/Month
Childcare Tax Credit
£/Month
Pension
£/Month
Pensions Credit
£/Month
Partner’s Earnings
£/Month
Housing Benefit
£/Month
Council Tax Benefit
£/Month
Income Support/Job Seekers Allowance
£/Month
Universal Credit
£/Month
Grants from other Charities
£/Month
Any other income/benefits (includes furlough, SEISS)
£/Month
TOTAL INCOME

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5. Expenditure
Expenditure £
Water Rates
£/Month
Council Tax
£/Month
House Insurances
£/Month
Gas/Electricity
£/Month
Phone
£/Month
Childcare
£/Month
Rent
£/Month
Mortgage
£/Month
Medical costs
£/Month
Travel and vehicle expenses
£/Month
Debt repayments (loans, credit cards)*
£/Month
TOTAL EXPENDITURE

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6. Savings and assets
Savings
Bank balance/s:*
£
Other savings balance/s:*
£
TOTAL SAVINGS
Assets:
Property value (single/joint ownership)
£
Second property/s value
£
TOTAL ASSETS
Debts
Bank account overdraft
£
Credit card balance
£
Other loans
£
Mortgage arrears
£
TOTAL DEBTS

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7. Reason for applying
What do you need help with?
- Living costs (use this for COVID-19)
- Wellbeing/Injury
- Retraining
Living Costs
Please provide a statement about how a grant/bursary will help you in your current circumstances
If you are applying for a specific item, e.g. household goods, please provide details of cost
Please attach quotes or supporting evidence for household goods
Drop files here or
Wellbeing/Injury
Please provide a statement about how a grant/bursary will help you in your current circumstances
Please provide as much information as you can about your diagnosis
Has your treatment been recommended?
- Yes
- No
Please provide details of recommended treatment and cost of treatment
Please attach letter/report of recommendation- we are unlikely to fund treatment without this
Drop files here or
Retraining
Please provide a statement about how a grant/bursary will help you in your current circumstances
Please provide information about your reasons for retraining, including whether you have been accepted on to the course, or if not, when you expect to hear
Please attach any relevant documentation, such as course provider
Drop files here or
Please provide a breakdown of your income and expenditure while you are retraining (normally this will be different from your usual income and expenditure)

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8. Bank Details
Please provide details of your bank account (account name, account number, sort code) that would be used to make a grant payment to you
Account Name*
Account Number*
Bank Sort Code*
9. Consent
DATA PROTECTION The details and sensitive information you have provided in this application form will be kept confidential in line with our Privacy Policy. The Dance Professionals Fund will never use it for any purpose other than in relation to your application for support.
Please read and approve the declaration:
I give my consent to Dance Professionals Fund to process this information for the purposes of:
- My application being considered for a grant by the Applications Committee.
- The Dance Professionals Fund sharing my details with other charities that may be able to assist me (where this is the case, we have sharing agreements in place, in line with GDPR).
I understand that Dance Professionals Fund will hold my personal data and information for as long as is necessary and will delete it after this time.
I have read the Dance Professionals Fund Privacy Policy.*
The particulars that I have given on this application form are to the best of my knowledge correct.
- I agree and approve
I have read the COVID-19 grant guidelines prior to submitting this application*
Yes I have read the guidelines
CV
Drop files here or
Bank Statement (can be redacted if you prefer)
Drop files here or
Documents relating to loss of income
Drop files here or
Contact
We send out a regular newsletter about our work.
- Post
- Email
- Post & Email
- No
If you consent to us contacting you for this purpose, please ‘Opt In’ by ticking the box to confirm how you would like us to contact you:
Comments
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