Wicked World Tours Travel Application Form

You can fill in the form online, or download a printable version [Word, 271kb].

Before filling in the form, applicants are encouraged to read the accompanying Terms of the Award and Guidance for Applicants. We try to help cover the extra costs of travel faced by people with a disability.

Name*
First Last
Date of birth*
Address*
Postcode*
Country*
Telephone number
Email address*
Name and Address of Referee
e.g. teacher, youth worker, doctor, nurse, social worker
What is your disability? Explain how it affects your travel plans
i.e.what will cost you extra because of your disability?
Purpose of travel
Is it an adventure or educational?
Where do you plan to go?
How will you travel and what type of accommodation is planned?
Who will be travelling, including any accompanying carers?
Cost of travel
Please be as specific as you can at this stage.
What is the extra cost because of your disability?
Amount of grant you are asking from this trust, and how you will use it
Please be as detailed as possible
Other sources of funding applied for, and for how much
Other information
Please use the following space to explain at greater length anything which you would particularly like the trustees to know: for instance, more about your reasons for the planned travel, why you consider it adventurous or about any special requirements you have because of your disability.
Privacy
To promote Wicked World Tours, your report (or a part of it) may be used in publicity. Please select one of the following choices.
- I give permission to use excerpts from my report, which may include my name and any photos submitted, for promotion of Wicked World Tours.
- I give permission to use excerpts of my report, but not my name or identifying photographs, as I prefer to remain anonymous.
Declaration*
- I have read, understood and agreed to the terms and conditions
Email
This field is for validation purposes and should be left unchanged.