APPLICATION FOR FINANCIAL ASSISTANCE
To comply with the terms of The Tracy Trust Charity, would you please complete the following:
I am applying for financial assistance for: (state item, service or treatment)
…………………………………………………………………………….
I confirm that I have no reasonable alternative means of paying for this.
Signed: ………………………………………………………………….…
Date: ………………………………………………………………………
Please print full name and address below:
…………………………………………………………………………….
…………………………………………………….. SL2 ………………...
Email: …………………………………………………………………...…
Please ensure that you enclose all relevant documents / invoices.
All applications will be subject to approval by The Tracy Trust Trustees. Applications should not be made retrospectively.
Please return to the Treasurer: Rainer Struck, 9, Hedgerley Hill, Hedgerley, SL2 3RJ
Tel: 01753 646883
(Revised September 2021)