Independent Referee Statement

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The independent referee form should be completed and submitted alongside the Redhouse Youth Trust grant application form. The application will not be processed until this reference form is completed. The referee should not be associated with your organisation as a member, employee, volunteer or family member.

* = Required Field

Referees Name

First

Last

Occupation

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Telephone Number

Email Address

Name of person / group you are providing this reference for:

How long have you know of the person / group?

How do you know of them?

Please state why you believe this person / group is requesting the financial support and if successful how it will benefit them?

Signature

Clear Signature

By completing this form and signing this you confirm that your reference is true and correct. You may be contacted to discuss your comments.

Date Signed

BUSINESS INFORMATION