Children & Families Emotional Wellbeing Fund Application Form

Children & Families Emotional Wellbeing Fund Application Form

Please refer to the background and guideline notes before completing this application. If you have any queries relating to this application please call Monira Chowdhury on 0117 304 1409 or email

Section A – Contact Details

1. Your details:

Name of your Group or Organisation:
Your Name:
Your Role:
Contact Address:
Post Code:
Telephone number:
E-mail address:
Group/organisation website or any other internet/social media presence:
Charity number and/or company number (if applicable):

Section B – Funding Details

2. Please tell us briefly about your group or organisation: What do you do?

3. Your idea

Please tell us about the piece of work you are asking us to fund

a)  Description of your activity: and what it hopes to do:

b)  How will your activity promote early intervention and prevention around the emotional wellbeing of primary age children and promote anti-stigma?

c)  How many children and families will benefit from your activity, who they are and how are you going to engage with them? Is the activity targeted or focused on any particular group(s) or areas?

d)  How are you going to advertise/promote your project/activity?

e)  When will the piece of work take place?

f)  Start date:

End date (if applicable):

g)  How do you know there is a need? Who did you talk to? (For example have you spoken to families and children)

h)  How do you think your project/activity will meet the outcomes of the Fund?

i)  If you require funds to cover backfill to attend mental health training, please explain how the training will link into the activity and benefit children and families attending

Section C – Equalities

You have a responsibility to make sure your project/activity benefits and welcomes everyone and does not discriminate or excludes groups or individuals

Please delete or tick a or b below to say that you agree with one of the following statements:

4a.“We will actively make our project accessible to the whole community and will not discriminate against any group based on any characteristics.”

…………………………………………………………………………….

4b.“Our project is aimed at one specific equalities group or community of interest” (insert group/community).

………………………………………………………………………………

You will be required to keep monitoring information on basis of gender, ethnicity, disability, sexuality, faith, age and also related to geography and income

Section D – Finance

5. Please set out a breakdown of the total cost of your piece of project/activity, showing us which items you are asking us to fund and which are being funded from another source.

Please remember that you should request at least one written quote for each item or services over £500

Item / Cost
£ / Please tick(√) if you are asking us to fund this item. If you have other funding to pay for an item or part of an item please say where it is coming from (e.g. reserves, in kind, Lottery, Quartet, Neighbourhood Partnerships etc)
Add more lines if needed
Total Cost

You can apply for additional staff time to develop and deliver the activity or backfill to attend mental health training which enables delivery of the activity.

5a. How much are you asking for from the Emotional Wellbeing Fund

£

5b. Have you applied for funding anywhere else for this project/activity? (E.g. to any other funding source) Y / N

If yes please provide details, including when you will know the outcome:

5c. If you are awarded less money than you are asking for, will your project be able to go ahead? If it will, briefly explain how:

Section F – Policies

6. Does your organisation have the following policies/documents, you may be required to show them if requested: (for more information on what documentation you will need please refer to information which can be found via Voscur Support Hub http://www.supporthub.org.uk/resources or Bristol City Council https://www.bristol.gov.uk/npwellbeinggrants)

a.  A formal constitution or terms of reference Y/N

(set of rules for your group)

b.  A Health and Safety Policy Y/N

c.  A Safeguarding Policy Y/N

(this is required when you are working children and families)

d.  Public Liability Insurance Y/N

(this may also be required if you are holding activities)

e.  An Equal Opportunities Policy Y/N

Section F Payment Details

Costs incurred to deliver the activity/project must be claimed back using the Fund claim form and with receipts or invoices. The organisation providing administrative support to the activity/project may be able to request direct payment to a supplier for single large items such as venue costs (see guidance notes).

7. Does your group have a bank/building society account and do

cheques have to be signed by two signatories and/or do all withdrawals have to be authorised by at least two unrelated people? Y/N

7a. If your answer is YES to please complete the box below
Please give us the details of your group’s Bank/Building Society Account into which we should pay the grant if you are successful / Name of Account:
Bank/Building Society:
Branch:
Account Number:
Branch Sort Code:
7b. If you answered No you will need to find a formally constituted group to become your accountable body should your application be successful.
Please tell us below which group will be the accountable body for this piece of work.
Name of the group: / Address:
Please give us the details of this group’s Bank/Building Society Account into which we should pay a grant if you are successful / Name of Account:
Bank/Building Society:
Branch:
Account Number:
Branch Sort Code:
Please ask an officer from this Group (the Chair of the Group or the Group’s Treasurer or Chief Executive) to confirm that they are willing to receive the Grant on your behalf and act as accountable body for the funds.
I confirm we have read and understood the role of the accountable body that our group has agreed to receive an Emotional Wellbeing Fund grant on behalf of this group.
Name:
Group/Organisation:
Signed:
Position: Date:

8. DECLARATION: (please tick or delete)

8a. I declare that there is no link between the group/organisation and the persons who have given quotations for the items listed in this application

Or

8b. There are links between the group/organisation and the persons who have given quotations for the items listed in this application and those links are (please describe):

Please return completed form to:

or Community Access Support Service, Wellspring Healthy Living Centre, Beam St, Bristol BS5 9QY

Grant Deadlines: 10 November 2016, 10 January 2017, 10 March 2017, 10 May 2017 and 10 July 2017

Funding will not be given for any parts of the project that are started BEFORE the decision made by the Funding Panel. You may be contacted for further information after you submit your application or related to any query by the Funding Panel.

Please Note: that each round is dependent on funding still being available. It is the right of the panel to cancel deadline dates when all grant funding has been allocated

Page 9 of 9 September 2016