Foundation Derbyshire Flood Relief Fund - Phase One Application Form

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Use this form to apply for a £200 grant from the Foundation Derbyshire Flood Relief Fund.

If you are unsure about any aspect of the form please contact us on 01773 525860 or email

How to Complete this form

We recommend that you save your application by clicking on the "Save my progress and resume later" box above. You will be prompted to enter a valid email address and choose a password. You can then come back to it and resume it at a later date if you need to.

You can navigate to different pages on this form by clicking on a page number on the top right hand corner or using the "Next" or "Previous" buttons at the end of each page.

After completing the form you will be given an opportunity at the end of the form to review your answers before submitting the application. You can also print a copy to retain for your records.

Once you've submitted your application you will receive a confirmation email containing the information you submitted on your application.

Start Your Application Below
These are the details that we will use for correspondence purposes.

The contact person should be someone who has a good knowledge of the application as this is the person we will contact if we have any queries.

Address of the affected property (your main residence)


Page 2

Grants we award are paid by bank transfer (BACS). Please provide your full bank details below.


With this application, you must provide a copy (or image/photo) of a bank statement which proves that you live at the stated address.

Please use the link below to attach a copy bank statement or other documents.

Documents sent by post should be addressed to: 

The Grants Team

Foundation Derbyshire

Unit 2 Heritage Business Centre



DE56 1SW


Privacy Notice for Grants

Foundation Derbyshire takes personal data protection seriously. Personal data provided in this application form will be used to assess and administer the grant application for the Flood Recovery fund.

We request personal data about you because we may need to use this data for identification, debt tracing and the prevention of money laundering. You may be contacted by us to discuss the application. This enables us to request further information in regards to the application and supports the decision making process. We will notify you of the outcome of your application and if the application is successful you will be contacted as is appropriate for the administration of the grant. Personal data collected through the application process may be shared with our volunteer assessors (in order to evaluate this and any subsequent applications).

If you are providing any personal data about another person in this application form, you are confirming that they understand how their data may be used, stored, and shared. You have certain rights when it comes to your personal information. This includes the right to access and correct your information, to erase, transfer, object, restrict or withdraw consent around how we use your information. Please contact us if you or anyone named in your application have any concerns about how your information is used, stored or shared or if you wish to exercise any of these rights.

Retention of your personal information

Successful applicants will have their data stored for 7 years (our reason for processing this will be contractual). This enables us to comply with our financial procedures.

Unsuccessful Applicants will have their data stored for 2 years (our reason for processing will be under legitimate interest). This enables us to gather statistical data relating to our grant awards.

To submit your application please click on the "Submit Your Application" button below. You will be given the opportunity to review your responses before your application is sent.