Cura Grant

Name (required)

Email

Phone number (required)

Please explain why you need the grant? What would you spend the funds on?

This grant is aimed at people who are struggling financially. Can you afford to purchase this yourself?

What difference would the grant make to you?

Who suggested you applied for the grant? This must be a member of staff at East and North Hertfordshire NHS (which includes Mount Vernon Cancer Centre)

How did you hear about us

Word of mouthA leaflet or posterA member of staff

Please provide bank details - name

Bank

Sort Code

Account Number