Funding Application Form

Before completing this application form, please refer to our Guide for Accessing and Supporting Funds for advice about what the Charity is and is not able to support.

The guidance notes throughout the form also provide additional information about how to complete the form itself.

You cannot save the form as you go, so you may find it easier to make notes on the word document version then cut and paste your answers into the application form. Please note that only applications submitted directly through our website can be accepted.

Following form submission you will receive an automatically generated email to the email address provided with the detail of your application. Please remember to check your junk inbox.

If you have any queries prior to or during the completion of the application form please contact us by emailing [email protected].

Applicant's Name*

First Name Last Name

Applicant's Job Title*

Applicant's Department*

Applicant's Directorate*

Applicant's Site*

Applicant's Site Address

Please ensure that Street Address, City, Local Authority/County, Postcode and Country are completed

Street Address Address Line 2 City Local Authority/Region/County ZIP / Postal Code

Applicant's Work Email Address*

Applicant's Work Phone Number

Line Manager's Name*

First Name Last Name

Line Manager's Job Title

Confirmation of Line Manager's support

Please upload confirmation that your line manager is aware of and supportive of your application. (.txt files cannot be uploaded.)

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, doc, docx, xls, xlsx, Max. file size: 2 MB.

Project Name

Please provide a title for your project

What is your project?

Please outline your project in 250 words or less

What need is your project addressing?

Please tell us about the issues or gaps your project will address and how you know they exist. E.g. what observations have you made, feedback do you have etc.

How do you know that this project is an impactful way of addressing this need?

How much money are you seeking from NHS Lothian Charity?*

Please explain how you reached this figure

Please provide a breakdown about how the money will be spent. Please also note that NHS Lothian Charity observes NHS Lothian’s Standing Financial Instructions and procurement procedures.

If you will be purchasing anything for the project, please provide the email address of the person who will be placing orders.

In most cases, purchases will need to be made through PECOS. Does the person identified above have a Charity PECOS log in

Yes

No

Thank you for letting us know that the person you have identified as placing orders does not have a Charity PECOS login. We will create one and may be in touch separately regarding this.

For some purchases or payments that are not possible through PECOS, we will transfer the money to your cost centre. Please provide the cost centre below:

If you have a quote or an image that you would like to include, please upload this below.

Drop files here or

Max. file size: 2 MB.

Please tell us how you will implement your project?

Please provide details about key milestones, timelines, who will be involved to deliver the project, etc.

What is the plan for when the money from this application has been fully spent?

Please tick all that apply

Items will still be in use

The project will be complete

The project activities will be embedded in regular practice

We will be seeking continuation funding from NHS Lothian

We will be seeking continuation funding from NHS Lothian Charity

We will be seeking continuation funding from another source

Please provide more information on the answer given above

NHS Lothian Charity's Terms and Conditions for Charitable Funding

Before submitting your funding application, please read our Terms and Conditions for Charitable Funding

I confirm that I have read, understood and agree to NHS Lothian Charity’s Terms and Conditions for Charitable Funding

Phone

This field is for validation purposes and should be left unchanged.

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