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APPLICATION FORM
DEMENTIA SERVICE GRANT (ORGANISATIONS) 2014 – 2015
Have you applied before in this year for this grant? Yes [ ] No [ ]If yes, when did you apply (month/year)?
Name of organisation:
Contact details
Contact name:
Position in organisation:
Contact address incl postcode:
Telephone number(s):
Email address:
Can we add you to our mailing list to receive our newsletters? Yes [ ] No [ ]
How did you hear about this fund?
About your organisation
Please describe the main activities of your organisation and the areas of Cornwall you cover.Please tick to confirm your organisation is not commissioned to provide the intended activities by NHS Kernow, Cornwall Council or IOS Council [ ]
Does your organisation have Public Liability Insurance? Yes [ ] No [ ]
(This is a requirement of funding)
About your intended activities or events
Please tell us about the activities or events for which you are seeking funding. Please include the following information and continue on a separate sheet if needed:• The date(s) they will take place
• Where they will take place (must be in Cornwall)
• How many memory cafes or dementia support groups will benefit (min 10)
• How the intended activities will support memory cafes/dementia support groups
• Please tell us about any other organisations or groups you may be linking in with
You must have the support of at least 10 memory cafes/dementia support groups – please list the individual groups here
You will need to submit a written statement from each group that confirms their agreement for you to provide a service for them or on their behalf. Each group will need to include in their statement that they meet the Memory Café/Dementia Support Group Eligibility Criteria as detailed in the accompanying guidelines. Failure to include these statements could result in your application being rejected.
Finance
If your application is successful, payment will be made by BACSHow much money are you applying for?
Max £3000 in total per application / £
Name of bank/building society:
Bank account name:
Bank account number:
Sort code:
This grant
Please provide a breakdown of all costs for your group below, highlighting what you want this grant money to be specifically spent on.Type of cost
e.g. craft materials @ £50 per group / Total cost £ (inc. VAT)
Total activity or event cost / £
Independent referee
This should be someone who knows your organisation and supports your application for funding. This cannot be members of your organisation or family.Name:
Position (if applicable):
Address incl postcode:
Email address:
Tel. no.
How does this referee know about your group?
Declaration/Agreement
Name of your organisation: ______· I agree to the terms and conditions of the Dementia Service Grant (Organisations) as they are set out in the guidelines that accompany this application form.
· I understand that if my organisation is given a grant, we will only use it for the item or activity stated in this application form. If we need to use the money for something else, we understand we must get permission from CRCC first.
· I agree to complete a feedback report on how the grant was spent and how it has helped carers, and agree to send in all relevant receipts.
[ ] I confirm that the information provided in this application is true and accurate to the best of
my knowledge.
Name:
Date:
Checklist
Please tick to say that you have completed the following:
[ ] Please ensure all sections of the form are completed and you have signed the agreement above.
[ ] Please check the application guidelines carefully, particularly the Eligibility Criteria and
Exclusions.
Next steps
When you have completed this form, please post this form to: 2 Princes Street, Truro TR1 2ES
Please ensure you include all requested documents.
If you need to call us, our number is: 01872 243532
The application deadlines for this year are:
3 June 2014 29 August 2014 21 November 2014 20 February 2015
Data Protection
This information will be stored electronically and will remain confidential to CRCC. We will seek your written agreement before using it for any purpose other than that described herein (such as use by a third party).
Dementia Service Grant (Organisations)
Grant Guidance Notes
Cornwall Rural Community Council
CRCC is a Cornish Charity that informs and guides local groups and individuals to achieve their aspirations and develop sustainable, inclusive communities. CRCC provides support to a wide variety of groups and individuals and embraces equality and diversity. The support can be, for example, with rural communities, minority and excluded groups, BME communities, those in poverty or unemployed, providing a voice for those with views on health and social care services and also enabling community groups to bring to fruition community projects and social enterprises.
What is the Dementia Service Grant (Organisations)?
It is the aim of the Dementia Service Grant to allow organisations to provide a countywide service that will support memory cafes and dementia groups. The service should provide support to groups who enhance people’s health and wellbeing, who assist people with dementia in accessing a range of local support networks and community resources, and so help people with dementia to increase their independence and reduce the need for specialist care or hospital services.
Organisations can apply for a grant to a maximum of £3000 per application.
Eligibility Criteria - organisations
• The service must provide support to at least 10 memory cafes or dementia support groups and written statements of agreement from these groups must be submitted with the application form.
• Groups benefitting from the grant-funded activity must comply with the Group Eligibility Criteria and Exclusions (see below).
• Organisations must be based in Cornwall and only benefit residents of the county. Activities funded through this grant must take place in Cornwall.
• Eligible services are: Public Liability Insurance; subscriptions to resources, maintainance of a countywide network and training sessions or workshops.
• Organisations must not be commissioned by Cornwall Council, IOS Council or NHS Kernow to provide this activity.
Exclusions - organisations
• Applications that make no reference to the aims and objectives of the grant will not be accepted.
· Travel expenses for beneficiaries are not included, however staff travel and facilitation costs directly relating to the grant-funded activity are permitted.
• Applications must not exceed £3000 per year.
• Items and activities already paid for cannot be reimbursed through this grant.
Group Eligibility Criteria
Groups benefitting from the grant-funded activity must comply with the following:
• Groups must have a minimum of 4 people and people with dementia must make up the majority of group members.
• Groups must be based in Cornwall and only benefit residents of the county.
• Groups must have a steering group or committee.
• Groups must link to a professional or recognised organisation who can vouch for the group. The professional or organisation must be from:
* NHS provider * CRCC
* Cornwall Council * IOS Council
* Age UK Cornwall * Arts for Health
* Memory Matters SW * Alzheimer’s Society
* Volunteer Cornwall
We suggest that you copy and paste the above criteria and ask groups to email or write to confirm that they comply when submitting their statement agreeing to your service.
Guidelines
• Grants must be spent on the activities or events approved and applications must detail how the grant will benefit the groups named.
• Contact details for a suitable referee who can vouch for your organisation should be supplied in the event of a query regarding your organisation and its activities.
• Organisations must keep all receipts and invoices relating to this grant. CRCC will require an End of Grant Report to be completed by the organisation once the activities or events have taken place and all receipts must be submitted with this. You might wish to send in photos and testimonials to support your report.
Next steps
Once we have received your application we will check it meets the above criteria; we may contact you by telephone to discuss the application in more detail. Therefore please ensure the contact provided is available during office hours and has knowledge of your application details. We recommend that you take a copy of your application form, as you will need to refer to it if we have any queries and when completing your End of Grant Report. Following this initial check, your application will go before the grant panel who will decide on its suitability for funding.
The application deadlines for this year are:
3 June 2014 29 August 2014 21 November 2014 20 February 2015
The grant panel will meet approximately 3 weeks after each deadline to assess applications. You will receive the result of your application in writing within 5 working days of the assessment and, if successful, an offer letter will be sent outlining any conditions of your grant. Decisions by the panel are final and there is no right of appeal.
Change of Grant use
The grant must be spent for the approved purpose and failure to do so could result in a request for funds to be returned. If your circumstances change and you wish to amend your original activity, you must notify CRCC in writing detailing the proposed change and await approval by the grant panel before proceeding with the new activity.
Monitoring and evaluation
Organisations must agree to complete an End of Grant Report on a standard form supplied by CRCC. The End of Grant Report must be completed no later than 6 weeks after your activity end date or within 1 month of the end of the financial year (March 2015). When returning the form please include copies of receipts and invoices obtained for all items purchased. No further grant applications will be considered until this has been received and approved by CRCC.
Need more information?
If you need more information please contact:
CRCC
2 Princes Street
Truro
Cornwall
TR1 2ES
Tel: 01872 243532
Email:
1 CRCC charity no. 1087550 Dementia Service Grant (Organisations) 2014-15