The Rose Charity

Martlets House, Sedgehill, Shaftesbury, Dorset, SP79HQ

Registered Charity No. 900590

Covering Warminster & Surrounding Villages in the BA12 area

All Applicants please consider the following before applying:

  • Your basic needs.
  • How much / how often would you use the item/ equipment?
  • What difference would it make / what benefit would it be to you?
  • Do you own or have the same or similar product at the present time?
  • Is it possible for you to pay for, or contribute to, the cost of the product?
  • Do you have disabilities which have created a situation which makes it necessary to have this product?
  • Do these disabilities prevent you from doing certain things? If so please explain in as much detail as possible. Failure to do so may mean that your application is not approved.
      (Please be assured that this kind of information will only be discussed by the Trustees as they try to decide on your application).
  Should your application be approved, the Trust's policy is to pay the supplier and not the individual.

  Please fill in all boxes to help us properly review your application.

Name Applicant:   Address:   Town:   Post Code:   Phone:   Email:
Name (Parent/Guardian)   Address:   Town:   Post Code:   Phone:   Email:
Name of Child in need of funding:   Date of Birth   School Attending:
Purpose for which funding needed ie educational trip or other, but if it is for uniform then please list the items & sizes required & not the amount required, as we can only help with branded items from Scholas.
Amount of funding required:   State any any contribution you have or are going to make:
Other Charities - Have you or are you going to apply to any other charity for funding ? - if "Yes" type name of charity else type "No"
Family Circumstances - Please give a brief outline as to why the funding is needed.
Other Benefits - Please confirm you are in reciept of one or more of the following: / Income Support / Income Based Job Seekers Allowance / Income Related Employment & Support Allowance / Support under the Part-V1 of the Immigration & Asylum act 1999 / Guaranteed Element of Pension Credit / Working Tax Credit-Run On.
Community Professional - Please list the name and contact details of a person of professional standing, who knows you and your circumstances ie / Social Worker / Head Teacher / Doctor / who we may contact.
Cheque payable to:   Address:   Town:   Post Code:   Phone:   Email:
Signature - Type your name in box below to agree the information you have given is true and you agree that the Rose Charity may make any inquiries the trust feels necessary in processing this application.
Todays Date: example 22-04-2022

Finally ! if you need to print a copy of this completed form for your own records then click the printer icon and set your print setup to portrait mode.   print this page   before clicking SUBMIT button below.