Children’s Activity Fund

2017

Application Form

Organisation name
Project name
Application Number (for internal use only)
Name of your County Councillor(s)

Section 1

Your contact Information

Main contact details

1.1Please fill in the following details about the person in your organisation who will be the main contact for your application. We will contact this person to discuss your application in more detail should we need any further clarification.

Name of main contact

Title / First name / Surname
Position in organisation
Name of Organisation
Address for correspondence
Postcode

1.2Please enter your telephone number(s) and email address

Daytime
Telephone number
Mobile number
Email address*

1.3Please provide the name and email address of your main publicity and promotion contact so a promotional information pack can be sent to them to help manage this should your application be successful.

Name: / Email address:

1.4What is the legal status of your organisation (tick only one box)

Parish / Town Council
Company limited by guarantee / Company number
Company limited by shares / Company number
Charitable Trust / Charity number
Unincorporated organisation /
Not for profit organisation

1.5 If your organisation is a branch of a larger organisation, please tell us which one.

1.6What are the current activities of your organisation and how are these managed?

Please note:

If you run an activity for children under the age of 8 years if age you may need to meet Ofsted Early Years regulation requirements.

1.7Please tick if your organisation is on the Ofsted Early Years Register and /or Childcare Register

The Early Years Register URN

The Childcare Register

Section 2

Your local county councillor

2.1Please give the name of your local county councillor and the amount you are applying for. If you are applying to more than one division for funding please list below each councillor and the amount of funding being applied for from each divisional allocation. Your councillor can be found by visiting the county council web pages

Name of member(s) / Amount of funding applied for

If submitting an application for £5000, including this information at the same time will help speed up the grant award process if your application is successful.

Section 3

Purpose of your application

3.1Please be as specific as possible.

What is the need for your activity project?
What activities will you deliver and how?
What are the expected outcomes for children and community?
How many children are expected to benefit from this activity?
Is your activity project aimed at a particular group of children (for instance, boys, girls, disabled children, those from a particular ethnic, faith or traveller community)?

3.2Please enter details of the start and end date of your project*

Project Start Date / /

Project End Date / /

Section 4

How the money will be spent

4.1Please detail how the money you are applying for will be spent. For example, a grant expenditure of £750 for a basketball summer school might be split as follows:-

Costs
/ Description / Item / Number / Total £
Staff costs / Sports Coaches / 1 @ £20 each per session – 10 sessions / £200.00
Premises costs / Room Hire / 10 @ £30 per session / £300.00
Marketing / Leaflets
Posters / 500
50 / £75.00
£25.00
Equipment / Bibs
Basketballs / 20 @ £5 each
5 @ £10 each / £100.00
£50.00
TOTAL / £750.00

Please complete your cost break down below*

Costs / Description / Item / Number / Total £
Staff costs
Premises costs
Marketing
Equipment
Other
TOTAL / £

Section 5

Certification Please read the following paragraphs carefully.

We certify that the project details given in sections 1, 3 and 4 and that the proposed grant will be spent on that project.

We undertake with the council that if a grant is made towards the project, the grantee will comply fully with all the conditions set out in this document.

Signature of applicant (the person whose name and address is given in paragraph 1.1)*.

(Please provide your signature)______

Name (please print) ______

Date ______

If your application is successful you may be asked to submit the following documentation. Please tick that you are able to provide us with:

□A copy of your latest statutory accounts or approved management accounts*

□A copy of your safeguarding policy or an outline of your procedures

□A copy of your equal opportunities policy or an outline of your procedures

□Any other information/documentation requested in support of your application

* If submitting an application for £5000, including this information at the same time will help speed up the grant award process if your application is successful.

Please be advised, we will only process applications submitted via your County Councillor and will not accept any applications sent directly to us. Please forward this application to your local County Councillor for their endorsement below.

Member declaration

By submitting this application the councillor confirms that the proposed application:
  • is within their electoral division budget allocation;
  • is consistent with the Council's policies and objectives;
  • will not give rise to an on-going financial commitment;
  • will not be used for hospitality or gifts
And that they have:
  • disclosed any pecuniary interest in the proposal
  • disclosed any other interest in the proposal
If the project is being supported by more than one councillor please ensure all councillors have provided a signature or a supporting e-mail of confirmation.
Signature: Date:
Signature: Date:
Signature: Date:
County Councillors can only send applications directly tous via email.