Equipment or Service Funding Request

Please read before completing your application below:

The first underlying principle of the Sussex Heart Charity is to improve in the county of Sussex, the quality of cardiac patients’ lives and their families, and to promote and facilitate resuscitation in the community.
Funding requests must first be submitted to the local NHS Trust. If NHS funding is not approved or rejected, Sussex Heart Charity will consider funding the project, provided appropriate evidence of NHS’s decision and reasons are provided.
With respect to governance issues and the Charity Commission, the Sussex Heart Charity is not able to supply equipment or services which are clearly the statutory responsibilities of your local NHS Trust to provide.
All requests by NHS or other health care providers should be for additional items of equipment, facilities or services, and not for replacement of existing items.
With respect to equipment grants the applicant will have to guarantee mechanisms are in place for ongoing financial support and maintenance.
Retrospective claims will not be considered.
Incomplete forms will not be considered.
All applications will have a time limit to be used within 6 months from date of being awarded. After this date the funding will be withdrawn, and a new application would be necessary.
All grants are at the trustees’ entire discretion including as to the merits of the particular application, priority and availability of funds.

Your Details

Title *

First Name *

Last Name *

Job Title *

Name of Hospital/Department or Organisation *

Your Email Address *

Contact Phone number *

Are you part of, or affiliated to a larger hospital Trust or Community Organisation? *

Please provide details *

How much are you requesting? *

All prices to be inclusive of VAT

Are you seeking or have you received funds from any other organisation for this proposal? *

Please give details *

You must have sought funding from your own organisation before applying.

We are unable to fund equipment or services that should be the responsibility of other organisations.

Have you been unsuccessful in obtaining funding for this proposal from any other organisation? *

Please give details as to why you were unsuccessful *

Document Upload

Please upload the proposal/business case and the response you received.

What are you requesting funding for? *

Please give us a thorough description/explanation of the equipment/project.

How will this project benefit cardiac healthcare/patients? *

Will the outcome of the project require ongoing maintenance? *

Please provide an estimate of how much any ongoing maintenance will cost *

Please provide details *

Name of Supplier *

Website of Supplier *

Address

Country

City

State

Zip code

.. *

Please provide links to product pages, online brochures, reports, manuals or anything else you feel is relevant to your application

Document Upload

Please upload any received supplier quotes or other relevant information.

I declare that the information given on this form is true and that any funds received would be solely for the purpose as detailed above.
I have fully completed this application form and enclosed cost estimates.
I agree to make invoices/receipts available on completion of the project on request.
I agree to abide by the conditions set out by the Sussex Heart Charity in making the award.
I agree to return any grant made if it is no longer possible to proceed with the purpose of the application.
I have read and understood the section above this form.

Check to confirm and submit your application *

I AGREE

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