Chrysalis funding - suggestion form

Your details
1. Title*
2. First name*
3. Last name*
4. Do you live, work or study in the Borough?*
  
  Live
  
  Work
  
  Study
  Tick all that apply
5. Address*
7. Postcode*
8. Is this your:*
  
  Home address
  
  Organisation's office
9. Telephone*
10. Email*
11. Where did you hear about the Chrysalis Programme?*
  You can enter up to 150 words
12. Who is your suggestion made on behalf of?*
  
  Yourself
  
  Charity
  
  Community association
  
  Residents' Association
  
  Organisation
  
  Other
13. Please provide details
14. Position / association with the above*
  Enter 'N/A' if none held.
15. I confirm that I am 18 or over*
16. I confirm that I have read the criteria*
  
  See www.hillingdon.gov.uk/chrysalis for details of the criteria.
17. Your idea
  1. Location/address of improvement*
  2. Please give details of what the Chrysalis funding will be used for?*
    You can enter up to 2000 words
  3. Why have you suggested this?*
  4. If possible, please include a cost breakdown (Optional)
    You can enter up to 2000 words
  5. Who in the community would benefit?*
    You can enter up to 2000 words
  6. If you would like to send us additional supporting information, please send to our email address: chrysalis@hillingdon.gov.uk
18. 1. Please note, that by providing your details you are giving us permission to share your details within the council, our partners and other grant providers. This may be necessary in order to deliver your suggested project. This information will never be provided to commercial organisations for marketing purposes but may be passed along to our appointed contractors if needed, to deliver your suggested project.
  2. I acknowledge the above notice.*
  3. Label
    
    Date*
19. Privacy notice: The London Borough of Hillingdon (LBH) is the data controller in regards to any personal data you submit using this form. LBH processes personal data in line with its obligations under data protection legislation. For more information on how LBH will process your personal data please visit www.hillingdon.gov.uk/privacy.