Please read the guidance notes before completing this form. If further help is needed,
please contact the Secretary/Treasurer.

Name ………………………………………………………………………

Date of birth ..………………............... (If a grant is awarded, proof of this date may be required.)

Address (including postcode) ………………………………………………………

…………………………………………………………………………………………

E-mail…………………………..............................

Telephone …………………………

Are you or have you ever been a pupil at either Cutcombe or Timberscombe First Schools?
If so, please give dates:

………………………………………………………………………………………………

Are you or have you ever been resident in the parishes of Timberscombe and Cutcombe
and in that part of the parish of Selworthy known as East Lynch?
If so, please give dates:

……………………………………………………………………………………………..

How much are you applying for? Please indicate what proportion of the total cost this is:

………………………………………………………………………………………………

Do you have deadline for a decision on this application? If so, please explain:

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