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Youth Community Chest Grant Application Form 2017

Note: Please read the Guidance Notes in detail before completing this form.

Section A: Contact details

1. Name of your organisation

2. Address of your organisation

Postcode:

3. Website address of your organisation (leave blank if not applicable)

4. Lead contact for the organisation

Name:
Position:
Email address:
Telephone: / Office: / Mobile:
Section B: Project outline

5. Please provide your title for your project / activity:

6.Please give a brief description of what activity you are providing / equipment is being requested and why? (Please include who will benefit from this funding and how)

7. What day will/does your activity run? (Please underline)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Various

8. What time will/does your activity run? (Please underline)

MorningAfternoonEveningAll day

9. How many sessions will you be delivering over the period?

10. What is the duration of the session?

11. What age group will the activity be aimed at?

12. In total, how many young people will benefit from the grant over the 6 month funded period?

13. How are you going to monitor and evaluate the service provided in meeting the aims of the provision?

Parent/carer feedback form involving the young person  Surveys 

Other

14.How regularly will your organisation monitor and evaluate this?

WeeklyMonthly  End of the 6 month funding 

15.How will you market your activity?

Multimedia County Press  Posters Events 

Other

16. Type of organisation (please tick all boxes that apply):

 / Voluntary organisation /  / Registered charity /  / Early years setting
 / Community group /  / School / College /  / Business
 / Countryside/Environment /  / Libraries /  / Arts
 / Outdoors /  / Sports / Leisure Centre /  / Other (please Specify
below)
Section C: Project income and expenditure

17. Type of organisation (please tick which one that applies to you):

 / VAT Registered /  / Non VAT registered /  / Social Enterprise

18. Please complete each of the columns in the table below to provide details of anticipated project expenditure:

Description / Costs/£
Staff costs/Wages
Total Staff Costs
Other costs – Venue hire etc
Total Other Costs
Capital/equipment costs
Total Capital costs
TOTAL AMOUNT BEING REQUESTED / Amount/£
Section D: Applicant declaration
I declare that I have completed all relevant sections of this application accurately, and that this organisation has the authority to accept a grant under the grant conditions.
NB: The signatory must be a member of the organisation’s management team or the owner
Signed: / Position:
Printed name: / Date:
This information will be held in accordance with the Data Protection Act for the purposes of assessing and monitoring grant applications for a maximum of five years.

Supporting evidence: (please tick the following boxes, if you are sending any supporting evidence with your application)

 Health and safety policy

 Safeguarding policy

 DBS details (disclosure and barring service)

 Parents/carers or Childrens feedback/testimonies (compulsory for non Youth Offer providers)

 Any other supporting documentation

Please return your completed application form to:

Laura Reid

Community Action Isle of Wight

Riverside Centre

The Quay

Newport

Isle of Wight

PO30 2QR

If you have further queries please email :

Data Protection: The information you have supplied in this form will be used to process your grant application and for monitoring and statistical analysis purposes. Some of the information will be held on a database at The Isle of Wight Council