Disability Booster Pack 2019/20

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* 1. Name of club/ organisation

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* 2. Contact name

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* 3. Contact email address

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* 4. Contact phone number

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* 5. Are you applying on behalf of a club which is already affiliated to Surrey FA?

Yes

No

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* 6. Does your club have Charter Standard status?

Yes

No

Not sure

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* 7. Will you be using the funding to grow a new team (one which is not currently affiliated to Surrey FA)?

Yes

No

Not sure

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* 8. Which of the following options best describes the type team you will be growing? Please select all that apply.

Adult disability team

Youth disability team (please specify age group below)

Female disability team

Impairment specific team (please specify impairment group below)

Pan-disability team

Non disability team

Please specify below

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* 9. Have you received or applied for a Grow the Game grant or received funding from Surrey FA in the last 2 years for a disability team?

Yes

No

Not sure

If 'yes' what kind of funding was it, and when did you receive it?

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* 10. Please give a brief description of the project/ team you are looking to grow and why it is needed.

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* 11. What would you like to use the grant for? Please give a detailed breakdown below, alongside the total cost of each item (eg. 10 x size 5 footballs £100; league affiliation fee £150; set of 15 bibs £30)