Charity name* Charity Reg. No* Charity address* Address 1* Address 2 Postcode* Date of charity formation Name of main contact: Contact number* Email address* Charity website and/or social media address Aims and purpose of your organisation* How is your organisation constituted? (Company or Trust etc) How is your organisation funded? How is your organisation staffed? Amount of funding you require (Please note funding is capped at £1500) Provide a full breakdown of how the funding will be used? To ensure your application can be processed please provide as much detail as possible. List out what you require and how much it will cost Who will benefit from the funding? Total revenue income of organisation Total revenue expenditure of the organisation How did you hear about us? NIE Networks employee Friends or family Charity event Publication Website Facebook page Other I declare that the foregoing information is accurate Signed
