Please use this referral form if you or someone you know may need our assistance. Or download this PDF and once completed please save it and forward to us at info@pcnicolasfund.co.uk How we can help Referral Form Name Required Date How can we help? Required How will this help? Required How long for and what is the estimated cost? Required Does this fit in with our aims & objectives? Required yes no Aims and Objectives The aims of the fund shall be to support children and young people, who have lost an immediate family member to a violent crime, by providing grants or funding for educational opportunities and employment skills. If yes, how? If no, reason to support What will they gain from the support? Submitted by What was the relationship of the victim to person referred? Required Mum Dad Sibling Other Please state reason for referral if not a relative. Please note we can only provide support for relationships stated. Contact email: Required Submit
