Annex One-Application Form

Social Isolation and loneliness application

Overview

Working in partnership, the Harrogate and Rural District Clinical Commissioning Group (HaRD CCG), Harrogate Borough Council (HBC) and North Yorkshire County Council’s (NYCC) Public Health Department has up to £40,000 to be spent on developing an intervention/initiative to support the issue of social isolation and loneliness in older peoplein the Pateley Bridge, Boroughbridge or Masham areas. Please refer to the proposal for further details.

The funding is aone off fundingopportunity which must be allocated to a successful applicant by 21st October 2013.The intervention/initiative is to be completed by 14th November 2014.

The partnership are looking to encourage an innovative and self-sustainable approach to improve access to and availability of community resources, reducing feelings of social isolation and loneliness in the target population.

Applications are welcome from voluntary organisations, charities and community groups based in and serving the Harrogate and Rural District community.

Please refer to our website information on the vision, values and strategic priorities of the Harrogate and Rural District CCG can be found.

If you have any queries about the application form or application process please contact Kate Parker on 01423 799307.

Section 1: Contact Details for your organisation

Name of your organisation

Address of your organisation

Website of your organisation (if applicable)

The main contact for this application

(Please include full name, position, email address and phone no.)

Section 2: Your project / proposal

Please suggest a title for your project / proposal:

Please write a brief description of your project / proposal to include the following: (no more than 250 words)

  • Project purpose and objectives
  • Who will benefit from your project / proposal?
  • Which geographical areawill benefit most from your project / proposal?
  • How the evaluation of the intervention/initiative will be evidenced
  • End Result (outcome of the project)

How did you identify the need for your project / proposal?

(For example any research or surveys you have done or any national or local guidance –no more than250 words).

Section 3: Links with any priorities and other strategies

How does your project or proposal link to any broader strategies or plans, if any?(no more than 250 words).

Section 4: Finance for your project / proposal

Please provide a breakdown of how the £40,000 will be spent.

(no more than 250 words)

Section 5: Declaration

By ticking this box I declare that the information contained in the application is accurate at the time of submission. I will immediately inform Harrogate and Rural District Clinical Commissioning Group of any change of circumstance that will affect the project before or during it being undertaken. I agree that this grant will only be spent upon the project outlined in this application. I accept that all literature relating to the grant aided project will state “sponsored by” and feature the Harrogate and Rural District Clinical Commissioning Group logo as a condition of this grant.

Date:

Name:

Signature:

Data Protection

Details you have provided to Harrogate and Rural District CCG will only be used for the purposes of duly considering your application.

Submitting your application

Please submit your application either electronically to or via post to Kate Parker, Commissioning Manager, NHS HaRD CCG, 1 Grimbald Crag Court, St James Business Park, Knaresborough, HG5 8QB

by 14thOctober2013.

If you have not received confirmation of receipt of your application please contact us to check that it has been received.

If you have any queries please contact Kate Parker on 01423 799307

Applications will be considered by a panel representing:

Harrogate and Rural District CCG

Harrogate Borough Council

Public Health-North Yorkshire County Council

Views may also be taken from Harrogate and Area CVS

Applicants will be contacted by Monday 21st October2013 to be informed of the outcome of their application.

The successful applicant will be expected to start project delivery on 18thNovember 2013.