Application Form

Your full name*

Current Address

Phone number

Mobile number

Your email

Current occupation or status

What is your age / How old is the person you are applying for?

Amount applied for

What will you use the funds for?

Tell us why you are applying and how this will help your future well-being?

Have you approached any other organisation for funds? If so give details?

Data Protection Consent Form:  Parental Consent for Children’s Personal Data
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The Jim Agnew Memorial Charity (JAMC) requests your consent to process children's personal data to comply with the General Data Protection Regulations and other legal requirements. JAMC requires that children under the age of 16 years have written consent from their parent or guardian before we can process their application.
 
If you wish to know how we use your information or see a copy of our privacy policy please go to our website:  https://www.jimagnewcharity.org/policies/

Do you consent to our processing personal data about your child in connection with your application?
Parent or Legal name

Parent or Legal signature

Child Full Name

Child Signature (if over 12 yrs old)

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I believe all of the information given to be truthful and I accept I may be contacted using the information given above.