To apply online please ensure that you refer to the guidence notes available on this website. As well as that please make sure that you complete all of the fields marked with '*' as they are required fields without which your application will be unable to be processed. If you require any help completing the application then please contact Stuart Dunne at Blackpool Access & Participation Unit.

Applicant Name:
Date of Birth:	(DD/MM/YYYY)
Ward:
Contact Phone Number:
Email:
Grant Type:	Individual GrantGroup Grant
Number of young people completing this form:
Amount Applying For:
Is this the full cost of the project:	YesNo
Give a brief description of the project:
Please give a list of expenditure:
Which of the following does the project include:	- Sports - Culture - Recreation - Volunteering
Which of the following areas does the project fit into:	- Staying Safe - Being Healthy - Enjoying and Achieving - Economic Wellbeing - Making a Positive Contribution
How have young people been involved:
How many young people aged 13-19 will benefit from this project:
Has you or your group applied for money before:	- No If yes please describe?
If successful who would you like the cheque payable to:
(Applicants under the age of 18 must nominate a parent/legal guardian/group)
Support Worker Name:
Agency/Organisation:
Contact Phone Number:

"; # } # if(trim($_POST["appDOB_Day"])=='') { # $error_msg.="Please complete the day of your birth.
"; # } # if(trim($_POST["appDOB_Mon"])=='') { # $error_msg.="Please complete the month of your birth.
"; # } # if(trim($_POST["appDOB_Year"])=='') { # $error_msg.="Please complete the year of your birth.
"; # } # if(trim($_POST["appWard"])=='') { # $error_msg.="Please complete your ward.
"; # } # if(trim($_POST["appPhone"])=='') { # $error_msg.="Please complete your phone number.
"; # } # if(trim($_POST["appEmail"])=='') { # $error_msg.="Please complete your email address.
"; # } # if(trim($_POST["appCompleting"])=='') { # $error_msg.="Please complete how many young people are filling out this form.
"; # } # if(trim($_POST["appAmount"])=='') { # $error_msg.="Please complete the amount you are applying for.
"; # } # if(trim($_POST["appFullCost"])=='') { # $error_msg.="Please complete the full cost of your project.
"; # } # if(trim($_POST["appDescription"])=='') { # $error_msg.="Please complete the description of your project.
"; # } # if(trim($_POST["appBreakdown"])=='') { # $error_msg.="Please complete the breakdown of costs for your project.
"; # } # if(trim($_POST["appHowInvolved"])=='') { # $error_msg.="Please complete how young people have been involved in the project planning.
"; # } # if(trim($_POST["appYPBenefit"])=='') { # $error_msg.="Please complete which young people will benefit.
"; # } # if(trim($_POST["appChequeTo"])=='') { # $error_msg.="Please state who you wish your cheque made payable to.
"; # } # // display error message if any, if not, proceed to other processing # if($error_msg=='') # { $conn=mysql_connect( "$hnam", "$unam", "$pnam" ) or die(mysql_error()); $rs = mysql_select_db( "$dnam", $conn ) or die(mysql_error()); $sql="insert into cms_yof_apps ( appName, appDOB_Day, appDOB_Mon, appDOB_Year, appWard, appPhone, appEmail, appType, appCompleting, appAmount, appFullCost, appDescription, appBreakdown, appSporting, appCultural, appRecreational, appVolunteering, appSafe, appHealth, appEnjoy, appEconomic, appPositive, appHowInvolved, appYPBenefit, appBefore, appBeforeHow, appChequeTo, appSupportWorker, appAgency, appSupportContact ) values ( '$appName', '$appDOB_Day', '$appDOB_Mon', '$appDOB_Year', '$appWard', '$appPhone', '$appEmail', '$appType', '$appCompleting', '$appAmount', '$appFullCost', '$appDescription', '$appBreakdown', '$appSporting', '$appCultural', '$appRecreational', '$appVolunteering', '$appSafe', '$appHealth', '$appEnjoy', '$appEconomic', '$appPositive', '$appHowInvolved', '$appYPBenefit', '$appBefore', '$appBeforeHow', '$appChequeTo', '$appSupportWorker', '$appAgency', '$appSupportContact' )"; $res = mysql_query( $sql, $conn ); if($res){ echo( "Application Submitted" ); } } ?>