1. General Note
You must complete this form if you would like to request a grant from the Community Safety Hub (CSH). Firstly, your application will need to be approved by the Partnership Team, before being appraised by the CSH. See Appendix 1 for the conditions that apply to this grant.

Community Safety HubFunding Request Form

2. Submission of Application
Please returncompleted copies to
Hard copies can be sent to:
Oliver Greatbatch
Partnerships and Communications
Cannock Chase Council
Civic Centre
Beecroft Road
WS11 1BG
3. Applicant Contact Details
3.1 Name of organisation applying for the grant:
3.2 Status of organisation (e.g. registered charity):
3.3Name, position, address, telephone number and email address of the nominated person responsible for the management of the project that the grant is to be used for:
Please note that requests for funding from third parties will not be accepted.
4. Details of project requiring funding
4.1 Project name:
4.2 Description of the problem that the project will address (Please also state if this project addresses an issue identified at the CSH and whether there is any supporting intelligence/data):
4.3 Project description (What is it?What will it achieve?What could happen if the project does not take place?):
4.4Who and how many will benefit from the project (Please clearly state if the project focuses on a specific neighbourhood, crime type, or community of interest):
4.5Which other avenues for funding have been explored prior to approaching the CSH?
4.6When will the project be delivered?
4.7Please provide details of how the project links into the Local Strategic Partnership priorities:
  • Early Intervention - tackling the root causes before they become a problem.
  • Supporting Victims and Witnesses - making it easier for victims and witnesses to get the support they need locally.
  • Managing Offenders - preventing offending in the first place and reducing the likelihood of re-offending.
  • Increasing Public Confidence - making sure everything that happens in partnership contributes to individuals and communities feeling safer and reassured.

4.8What will happen to this project when CSH funding has been spent? How does the project deliver long-term benefits?
5. Partner Involvement
5.1 Please provide details of other partners who are involved in the development and delivery of the project:
6. Project Cost
6.1 How much will the project cost?
Capital (e.g. equipment)
Amount (£) / Revenue (Staff, rent, materials)
Amount (£) / Total
amount (£)
6.2Date by which funding is required:
6.3If funding you are receiving from the CSH is less than the total cost of the project, please state who else is providing funding and whether it has been secured/applied for:

7. Declaration

I certify that the project details given in sections 4-6 are truthful and accurate and hereby submit this request for funding to the Partnership Team and Community Safety Hub for their consideration. I also agree to submit a thorough evaluation, as provided by the Partnership Team, within four weeks of the project’s completion. I accept that failure to do so will result in a rejection of future funding bids.

Signed:

Full Name:

Position:

Organisation:

To be completed by the Partnership Team

4.2/4.7 (Relevant) / /10
4.3 (Specific) / /10
4.4 (Measurable) / /10
4.5 (Research-based) / /10
4.6 (Time scaled) / /10
4.8 (Sustainable) / /10
Total / /60
Approved/Rejected by Partnership Team*
*Delete as appropriate / Name:
Signed:
Date:

To be completed by the Community Safety Hub

Approved/Rejected by CSH*
*Delete as appropriate / Name:
Signed:
Date:

To be completed by the Partnership Manager

Are sufficient funds available for this project? / YES / NO
Approved/rejected by Partnership Manager on behalf of the LSP Strategic Board*
*Delete as appropriate / Name:
Signed:
Date:

APPENDIX 1

General Conditions of Grant

I.The Grant is non-transferable.

II.Activity costs incurred before the approval of the grant will not be accepted.

III.The Grant is made on the basis that the activity is able to proceed almost immediately (within reason).

IV.If it is established that the activity will cost less than the grant awarded the Grantee will immediately refund the difference to the Council.

V.The Grantee must provide full supplier details to the Council to enable a purchase order to be raised. This purchase order must be included on the supplier’s invoice or funds will not be released. Once a purchase order is raised and passed to the Grantee, the responsibility of the Council ceases.

VI.The Grantee will endeavour to ensure that the Community Safety Hub grant will be brought to the attention of the public and that any public information given includes an acknowledgement of that assistance. The Grantee will also inform the Partnership Team at Cannock Chase District Council of such publicity prior to the event.

VII.No part of the grant shall be used for the publication or promotion of any material or any material which in whole or in part appears to be designed to affect public support for any political party or group or for the promotion of sex, alcohol or illegal substances.

VIII.Projects or events which promote or condone extremist ideology, activities or terrorism cannot be funded.

IX.The Grantee shall not sell or dispose of any equipment or goods purchased with the grant without first receiving the LSP Strategic Board’s written consent. But this paragraph shall not apply to any equipment or goods which through use has reached the end of its economic life.

X.After the expenditure of the grant the District Council/County Council may request such information as it considers necessary to prove that the grant has been properly spent. This information may for example include copies of receipts and inspection of any equipment purchased. The Grantee shall keep all receipts and documentation relating to the activity for at least six (6) years after the receipt of the grant and will permit authorised representatives of the Council to inspect them.

XI.During the operation of the activity the Grantee shall adopt and maintain equal opportunity and anti-discriminatory practices.

XII.Any items purchased will need to make a contribution to LSP’s priorities as listed. Other issues will be considered on merit. Funds are limited.

XIII.Requests for funding from third parties will not be accepted.

[Note: for some types of grant, especially those for the improvement of buildings, additional conditions may be necessary.]

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