HAMPSHIRE AND THE ISLANDS HISTORIC CHURCHES TRUST
FORM OF APPLICATION FOR GRANT
Please read Notes & Conditions before completing this form		 Application nbr Listing/CA
Name and address of church or chapel Denomination
Diocese, if applicable
Name and address of applicant Position held
Telephone number
Email address
Name and address of architect or surveyor Telephone number
Brief history of church or chapel
Repairs and other work done in the last five years
Grants already applied for  
English Heritage Joint Scheme £..................
County Council £..................
Local Authority £..................
Other £..................
Other funds available £_________
Total   
 £
Grants offered/refused
Summary of repairs and other works needed
Continue on back if necessary
Estimated cost of works £..................
Contingencies £..................
Fees £..................
VAT @ £_________
Total   
 £
Is other work proposed in the next five years?   YES/NO
If 'yes' please give details
Contractor's name and address and
Conservator (if applicable)

Please forward the following items (non-returnable), with this form to: HIHCT Grants Sub-Committee, Boares Garden, Braishfield, Romsey, Hampshire SO51 0PQ
     1. Two general photographs of the church or chapel. (One exterior, one interior)
     2. The current quinquennial inspection or other report on the building& condition.
     3. A specification and drawings of the proposed works.

Registered Charity No: 299633
HIHCT form 1, April 2010