Monitoring Form

Charity / Organisation Name *

Donation Amount Received *

What did you use the money for? *

What difference did this make to the individual/family? *

Please describe their circumstances before receiving the donation and the impact.

We would welcome any quotes from the individual/family below.

How beneficial was the donation for the family? *

Would you like to give us any other feedback, particularly on your application process with The Squeeze? *

Would you be happy for us to use the above feedback for a case study? *

All individual/family personal details will remain anonymous.

Signature *

Date *