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BLACK COUNTRY LEP EXPRESSION OF INTEREST FORM
CONTACT DETAILS

First Name
Surname
Telephone Number
Email Address

REGISTERED LEGAL DETAILS

Company / Organisation
Building Name
Street
Town or City
Postcode
Company Website Address (if applicable)

PROJECT DETAILS

Name of Proposed Project
Local Authority (where the project / site is located)
Brief Project Description (max 50 words)
What Outputs is this project likely to deliver? e.g. Jobs, New Housing Units, Business Assists, Apprenticeships, Floorspace etc.
Have You Received Public Sector Funding Before?
Estimate of Funding Sought? (£)
What is the Funding Required For?
Estimated Project Start Date?

DECLARATION

I confirm that I am authorised by my organisation to make applications for funding.