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)