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Application Form

If you are applying for yourself or a member of your family, please see our application form. Please complete this form here and submit or you may request a copy from our Clerk. Please email [email protected]

If you are aware of someone who is experiencing a particular hardship and feel that the Charity may be able to assist, please in the first instance email our Clerk [email protected].

All enquiries are treated in the strictest confidence.

Bentham Charity Application Form

please answer the questions below and submit. Additional documents in support of your request may be uploaded if needed.

UPLOAD ATTACHMENT

Name of person applying *

Address

Email Address *

Please let us know who is living in your Household (How many adults and children)

How long have you lived in Broughton ?

Please tell us what support you are requesting? *

Please outline why you require this support and what difference it will make *

Date and Time *

Phone *

Signature *

If you need assistance in completing the form or have any questions, please contact the Clerk. The Trustees may contact you for further information and evidence to support your application. GDPR: Confidential details will not be disclosed to other parties and will only be seen by the Trustees and Clerk of the Bentham Charities.