Name of Organisation:   Address:   Post Code:   Is this a registered charity?           YES      NO If so, what is the Registered Charity No?   Date of Registration   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Please summarise your objectives: Name of Contact & Position held within Organisation Telephone no:   Email address:   For how much are you applying?    $ For what purpose(s) will you apply any grant? And how will the benefit of any grant be measured? No. of dogs currently kennelled/fostered:    No. of dogs re-homed in last 12 months:    Are these :           All pure-bredAll cross-breedA mixture of the two In the case of pure-bred dogs, do you (where possible) provide the new owner with pedigree papers?    YES      NO If not, why not? Number of staff (full/part time volunteers) :    Please state training staff have received: In the event of our making a grant to you, we may wish to use your work, and/or examples of the people who adopt dogs from your establishment, in publicity for the Trust or for Pedigree. Will you seek adoptors' agreement to provide their contact details to the Trust and, through them, to PEDIGREE® in respect of adoptions during 2010?    YES      NO   What is the name/address/contact details of your veterinary surgeon? Name of veterinary surgeon:   Address:   Postcode:   May we contact him/her in connection with your application?    YES      NO Please see the background material on this funding, and a broad statement of the criteria the Trustees, and their advisors, intend to apply in the award of grants. DECLARATION The above information is, to the best of my belief and knowledge, accurate. I understand and accept that the names of all successful applicants will be published, and that a representative of, or on behalf of, the Trust may visit my organisation in connection with this application. Name:   Position within organisation:     * We may wish to see your accounts - please be prepared to supply these if requested.