Black History MonthOctober 2018

BLACK HISTORY MONTH 2018

Application form for Small (up to £500) & Large (up to £2,000) grants

Type of grant requested
(tick√ one box only) / Small
(up to £500) / Large
(up to £2,000)
Please read the guidance notes completely before completing this application form. The guidance notes will provide details on how your application will be assessed.
Applicants are required to complete all sections. We cannot accept handwritten applications
The closing date for completed applications is Monday11 June 9am.
Applications received after this time will not be assessed.

Southwark Council

Black History Month

Communities Division
Housing & Modernisation Dept

Floor 5, Hub 3

P.O. Box 64529

London SE1P 5LX

  1. Your organisational details

Please refer to Point 2 on theguidance notes.

Name of organisation
What is the legal status of your organisation?
Please tick √
– more than one may apply /  Registered Charity (please provide registered number)
Charitable Incorporated Organisation (CIO)(please provide registered number)
Community Interest Company (CIC)(please provide registered number)
Company Limited by Guarantee (please provide registered number)
Unincorporated Association
 Other (please give details)
Name of director/manager of organisation
Address
Post code
Email address
Mobile number
Landline number
Website (if applicable)
  1. Details for correspondence

Give the name of the main contact person. This person should be easily contactable and able to answer questions about the application.

Contact name
Position in organisation
Address
Post code
Email address
Mobile number
Landline number
  1. Event(s)

Event status (tick one) / Proposed / Provisionally confirmed / Confirmed
Date(s)
Times (from and to)
Event location:
Address
Post code
  1. Budget and costings

Please refer to Point 6. and 7. on the guidance notes.

INCOME / AMOUNT
Black History Month grant being requested from Southwark Council
Any other event income.
Please state amount(s) and source(s):
TOTAL EVENT INCOME / £
EXPENDITURE / AMOUNT(S)
Venue costs (hire)
Technical requirements and support eg PA systems, equipment,lighting, stage
Please list what and how much
Practitioner/staff costs who will help deliver the event(s) eg artist, speaker, workshop leader, historian
Please state hourly rates or fee against each practitioner/staff member
Administration and office costs
Please list what the cost is for and the amount
Other additional costs.
Please list what they are and how much
TOTAL EVENT EXPENDITURE / £
  1. Project/event proposal(maximum 500 to 700 words)
Please refer to Points 3, 4, 5 and 9 in the guidance notes.
  1. Signed

Event organiser:

Date:

Print name:

Director/Manager:

Date:

Print name:

Please return completed applicationto:

Southwark Council

Black History Month

Communities Division

Housing & Modernisation Dept

Floor 5, Hub 3

P.O. Box 64529

London SE1P 5LX

Email:

Tel: 020 7525 4069

The closing date for completed applications is Monday11 June 9am.

Applications received after this time will not be assessed.

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