Creative Breaks 2017: Application Form

Creative Breaks 2017: Grant Application Form

About this funding

Creative Breaks is a funding programme of the Short Breaks Fund, operated by Shared Care Scotland on behalf of National Carers Organisations and the Scottish Government.

The purpose of the Short Breaks Fund is to increase the range, availability and choice of short breaks for carers and those they care for across Scotland.

The Creative Breaks programme provides grant funding to third sector organisations to develop and deliver short breaks projects and services for carers of adults (aged 21 years and over), carers of older people (aged 65 years and over), young carers (caring for children or adults), and those that they care for.

Help with your application

Before starting your application, please read the Creative Breaks 2017 Application Guidance carefully. You can download the guidance from our website:

The Short Breaks Fund team are here to help. If you have any questions about your proposed project or the application process, please contact us on 01383 622462.

Shared Care Scotland have a number of resources to help you prepare your application:

  • Easy consultation toolkit
  • Easy evaluation toolkit
  • Unit cost calculator
  • Sustainability guide

You can download all of these resources from our website:

Submitting your application

To submit your application, email putting the name of your organisation into the email subject line. Deadline for applications is 12 noon, Friday 26 May 2017.

Please attach the following documents to your email:

  • Completed application form
  • Detailed budget breakdown
  • Your organisation’s governing document or constitution
  • A copy of your most recent financial statement or accounts

Please do not send any other information at this stage.

Creative Breaks 2017: Grant Application Form

SECTION 1: APPLICATION SUMMARY

  1. Organisation name

Click here to enter text. /
  1. Project title

Click here to enter text. /
  1. Main contact for application

This must be someone who works or volunteers for your organisation.

Full name / Click here to enter text. /
Job title or role / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
  1. Project summary

Describe your project in no more than 50 words.

Click here to enter text. /
  1. Partnership project

Will this project be delivered in partnership with other organisation(s)?

☐ / YES / ☐ / NO
  1. Total cost of project

What is the total cost of your project (from October 2017 to September 2018) – to the nearest £1?

£Click here to enter amount.
  1. Grant requested from Creative Breaks

How much are you requesting from Creative Breaks – to the nearest £1?

£Click here to enter amount.
  1. Project location(s)

Which Local Authority Area(s) will your project take place in?

Click here to enter text. /
  1. Beneficiary numbers

Estimate how many carers and cared for people will benefit from your project (from October 2017 to September 2018).

Carers / Type no. /
Cared for people / Type no. /
  1. Hours of short breaks delivered

Estimate how many hours of short breaks your project will deliver for carers and for cared for people.

For carers / Type no. / Hours
For cared for people / Type no. / Hours
  1. Short Breaks Fund grants

Has your organisation received a grant from any of the Short Breaks Fund programmes before?

☐ / YES / ☐ / NO

Page 1 of 9

Creative Breaks 2017: Grant Application Form

SECTION 2: ABOUT YOUR ORGANISATION

  1. Organisation name

Click here to enter text. /
  1. Type of organisation

Tick one option below.

Registered charity / ☐ /
Other (please specify) / ☐ / Click here to enter text. /
  1. Registration numbers

Give all relevant registration number(s) below.

Charity number / Type no. /
Company number / Type no. /
Care Inspectorate / Type no. /
  1. Main address and phone number

This should be the main correspondence address and phone number for your organisation.

Address / Click here to enter text. /
Town/City / Click here to enter text. /
Region / Click here to enter text. /
Postcode / Click here to enter text. /
Phone / Click here to enter text. /
  1. Website and social media

Where can we find your organisation online?

Website / Click here to enter text. /
Twitter / Click here to enter text. /
Facebook / Click here to enter text. /
Other social media / Click here to enter text. /
  1. Main contact for application

This must be someone who works or volunteers for your organisation.

Full name / Click here to enter text. /
Job title or role / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
  1. Referees

Provide details of two referees. Referees must be familiar with your organisation and the proposed project, but not directly employed by or affiliated with you.

REFEREE 1
Full name / Click here to enter text. /
Organisation / Click here to enter text. /
Job title or role / Click here to enter text. /
Relationship / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
REFEREE 2
Full name / Click here to enter text. /
Organisation / Click here to enter text. /
Job title or role / Click here to enter text. /
Relationship / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
  1. Project delivery partners

You only need to answer this question if you ticked ‘YES’ in Section 1, Q5.

PARTNER 1
Organisation name / Click here to enter text. /
Key contact name / Click here to enter text. /
Job title or role / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
PARTNER 2
Organisation name / Click here to enter text. /
Key contact name / Click here to enter text. /
Job title or role / Click here to enter text. /
Email / Click here to enter text. /
Phone / Click here to enter text. /
  1. Partnership agreement(s)

You only need to answer this question if you completed Q8 above. Do you have a formal partnership agreement in place with your project delivery partner(s)?

☐ / YES / ☐ / NO

SECTION 3: ABOUT YOUR PROJECT

  1. Project title

Click here to enter text. /
  1. Creative Breaks outcomes

Projects must contribute directly to the achievement of at least two of the programme outcomes.Tick the outcomes your project will help achieve.

O1 / Carers and the people they care for will have improved wellbeing / ☐ /
O2 / Carers will have more opportunities to enjoy a life outside of their caring role / ☐ /
O3 / Carers will feel better supported to sustain their caring role / ☐ /
  1. Creative Breaks priorities

Projects that directly address one or more of the following priorities will be prioritised for funding. Tick the priority(ies) your project will address.

P1 / Choice and control: projects that seek to find new, more effective ways of increasing carers’ choice, control and confidence in accessing short breaks that meet their needs / ☐ /
P2 / Outreach: projects that actively seek to reach less visible and under-served carers, such as BME carers and carers from the Gypsy / Traveller communities, carers in remote and rural areas, carers living in areas of multiple deprivation, carers who are less likely to ask for or access support, and help them overcome barriers to accessing short breaks / ☐ /
P3 / Joint-working: projects that seek to work in partnership with other agencies to maximise the opportunities for carers to access short breaks that meet their needs, fill gaps and reduce duplication / ☐ /
  1. Project beneficiaries

Estimate how many people in each category will benefit from your project.

CARERS
Total number of carers / Type no. /
Of this total, how many are likely to be…
New to your organisation / Type no. /
Young carers (aged 18 or under) / Type no. /
Young adult carers (aged 19 to 25) / Type no. /
Black or ethnic minority carers / Type no. /
Gypsy / Traveller carers / Type no. /
Carers living in remote and rural areas / Type no. /
Carers living in areas of multiple deprivation / Type no. /
CARED FOR PEOPLE: ADULTS (aged 21-64)
Total number of cared for adults (aged 21-64) / Type no. /
Of this total, how many are likely to have…
Physical disability / Type no. /
Sensory impairment / Type no. /
Mental illness (excluding dementia) / Type no. /
Learning disability / Type no. /
Alcohol or substance addiction / Type no. /
Dementia / Type no. /
Autism / Type no. /
Long-term illness, disease or condition / Type no. /
Other condition/reason for needing care / Type no. /
CARED FOR PEOPLE: OLDER PEOPLE (aged 65+)
Total number of cared for older people (aged 65+) / Type no. /
Of this total, how many are likely to have…
Physical disability / Type no. /
Sensory impairment / Type no. /
Mental illness (excluding dementia) / Type no. /
Learning disability / Type no. /
Alcohol or substance addiction / Type no. /
Dementia / Type no. /
Autism / Type no. /
Long-term illness, disease or condition / Type no. /
Other condition/reason for needing care / Type no. /
  1. Why do you want to do this project?

Tell us how you know this activity is needed and relevant for the people taking part.Please don’t use this section to give us general statistics about the area or people or issue.Make sure you do include information about:

  • What issue, gap or need your project will address
  • How you found out about this issue, gap or need
  • What information you have that shows that this issue, gap or need really matters to people
  • What you’ve done to involve people in finding out about the issue, and planning the project so that it will address the issue

Click here to enter text. Maximum 500 words.
  1. What will your project do?

Tell us what your project will do. Make sure you include all the key information about:

  • WHO the project is for and how you will involve them
  • WHAT activities you will deliver
  • WHERE and WHEN the activities will take place
  • WHY this is the best approach
  • HOW your project reflects the principles of the Creative Breaks programme

Click here to enter text. Maximum 500 words.
  1. What will success look like?

Tell us about the difference your project will make to carers and cared for people. See page 6 of the guidance for more information on how to complete this section.

Outcome 1 / Carers and the people they care for will have improved wellbeing
What will success look like for your project in 12 months’ time?
Click here to enter text. /
How will you measure success?
Click here to enter text. /
What will you deliver in order to achieve this outcome?
Target 1 / Click here to enter text. /
Target 2 / Click here to enter text. /
Outcome 2 / Carers will have more opportunities to enjoy a life outside of their caring role
What will success look like for your project in 12 months’ time?
Click here to enter text. /
How will you measure success?
Click here to enter text. /
What will you deliver in order to achieve this outcome?
Target 1 / Click here to enter text. /
Target 2 / Click here to enter text. /
Outcome 3 / Carers will feel better supported to sustain their caring role
What will success look like for your project in 12 months’ time?
Click here to enter text. /
How will you measure success?
Click here to enter text. /
What will you deliver in order to achieve this outcome?
Target 1 / Click here to enter text. /
Target 2 / Click here to enter text. /
  1. Additional outcomes

Will your project deliver any additional outcomes? Use the blank table below to give details.

Outcome / Click here to enter text. /
What will success look like for your project in 12 months’ time?
Click here to enter text. /
How will you measure success?
Click here to enter text. /
What will you deliver in order to achieve this outcome?
Target 1 / Click here to enter text. /
Target 2 / Click here to enter text. /
  1. Longer-term impacts

Tell us about the possible longer-term impacts your project may have. This could include long-lasting benefits for carers or cared for people, influencing change in policy or practice, lasting change for your organisation etc.

Click here to enter text. Maximum 500 words.
  1. Why are you the right organisation to deliver this project?

Tell us about your organisation’s skills, expertise and experience, and any existing links with other relevant organisations that will enable you to deliver this project. Also, tell us about any support or development needs you have and how these will be met, and any new links or relationships you need to develop.

Click here to enter text. Maximum 500 words.
  1. Is there anything else you want us to know about the project or your organisation?

Tell us about any other documents or information that you think would strengthen your application. Please do not send these with your application. Our assessor will request further details if required.

Click here to enter text. Maximum 500 words.

SECTION 4: FINANCE

  1. How much will your project cost and how much are you requesting from Creative Breaks?

Complete the table below, telling us the total cost of your project, how much of this you are requesting from Creative Breaks and other funding required to make up the total.Please give all figures to the nearest £1.

Amount (£)
Total project cost / Enter £ /
Creative Breaks request / Enter £ /
Other funding / Enter £ /
  1. Detailed project budget

You also need to provide a detailed breakdown of your budget with your application using the Excel spreadsheet template provided. See page 7 of the guidance for more information on how to do this. Tick below to confirm you have submitted a separate budget (as an Excel spreadsheet) with your application.

☐ / Separate budget completed and submitted
  1. Other funding for the project

Complete the table below to tell us about other sources of funding for this project. How much have you already secured, and from where? What is your plan for securing any remaining balance? Use the text box beneath the table to tell us what will happen if you are unable to secure all of the funding required.

Source of funding / Secured / Anticipated
Type funder’s name / income source here / Enter £ / Enter £ /
Type funder’s name / income source here / Enter £ / Enter £ /
Type funder’s name / income source here / Enter £ / Enter £ /
Type funder’s name / income source here / Enter £ / Enter £ /
Type funder’s name / income source here / Enter £ / Enter £ /
Type funder’s name / income source here / Enter £ / Enter £ /
TOTALS / Enter £ / Enter £ /
Click here to enter text. Maximum 500 words.
  1. Your current finances

Please provide figures from your latest approved annual accounts

Accounting year ending / Enter date /
Total income for the year / Enter £ /
Total expenditure for the year / Enter £ /
Surplus (+) or deficit (-) at the year-end / Enter £ /
Total savings or reserves at the year-end / Enter £ /

You must provide a copy of your most recent accounts with your application.

  1. Is there anything you would like us to know about your financial position?

Use this section to give more detail about your organisation’s financial position. If you have high or low reserves, it is important that you explain why, and tell us what the organisation is doing to manage this. Also tell us if there have been any recent changes to your financial position which may not be reflected in your most recent accounts.

Click here to enter text. Maximum 500 words.
  1. Previous grants from Short Breaks Fund

List all previous and current grants awarded to your organisation by the Short Breaks Fund.

Year awarded / SBF Programme / Amount (£) / Reference
Type year / Choose an item. / Enter £ / Type ref no. /
Type year / Choose an item. / Enter £ / Type ref no. /
Type year / Choose an item. / Enter £ / Type ref no. /
Type year / Choose an item. / Enter £ / Type ref no. /
Type year / Choose an item. / Enter £ / Type ref no. /
Type year / Choose an item. / Enter £ / Type ref no. /

SECTION 5: FINAL STEPS BEFORE YOU SEND YOUR APPLICATION

  1. Declaration

By submitting this application, you are confirming that:

  • You have the authority to submit this application on behalf of your organisation;
  • The information provided in this application and accompanying documents is true and accurate;
  • Your organisation meets the eligibility criteria of the Creative Breaks programme and has the legal power to set up and deliver the work described in the application;
  • If your project involves working with children, young people or vulnerable adults you have the relevant registrations, policies and procedures in place;
  • Your organisation has appropriate and effective governance and financial management arrangements in place;
  • You agree we may use the information you have provided for purposes described under our Data Protection policy (available to view here).

Please check you have answered all questions. We can’t start assessing your application until it is fully complete.