Community Facilities Grant
Application Form 2015-2016
PLEASE REFER TO THE GUIDANCE NOTES BEFORE COMPLETING THIS FORM
Purpose of GrantValue of Funding Requested / £
Timescale
Start Date: / End Date:
SECTION 1: APPLICANT DETAILS
1 (a) Project Name
1 (b) Organisation Name
1 (c) Name of main contact in the organisation (the person we should write to)
Title First Name Surname
Position held in the organisation
Contact address, including full postcode
PostcodePhone: / Daytime / Evening
E-mail Address:
Website address
(if applicable):
1 (d) Please provide your bank account details
Account NameBank or building society name
Bank or building society address
Postcode
Sort code / - / - / Account No
How many people have to sign each cheque or withdrawal from this account?
Please list all the people who are authorised to sign cheques on this account.
1 Name / Position in the group2 Name / Position in the group
3 Name / Position in the group
4 Name / Position in the group
SECTION 2: SUMMARY AND AIMS OF THE ACTIVITY
Section 3: Business plan Max points: 40
All applicants must attach with this Application Form a full Business Plan, outlining all finance and details associated with the project, including sources of income for running costs. See Application Guidance.
Have you provided a copy of your Business Plan and supporting documents?
Yes No
Section 4: Evidence of need and community benefit Max points: 40
Please identify which of the Council’s priorities your application helps to address.
Section 5: Sustainability Max points: 10
Section 6: accessibility and equalities Max points: 10
SECTION 7: SUPPORTING INFORMATION AND DOCUMENTATION
This application must be accompanied by all RELEVANT supporting information. please indicate the documents which you have submitted.
Governance
· Memorandum and Articles of Association/Constitution Yes No
· Minutes adopting the organisation’s governing documents Yes No
· Minutes giving authority to apply for funding Yes No
· List of names and addresses of office bearers
Finance
· Income and expenditure projection for the first 3 years of the facility Yes No
· Latest and previous 2 years annual accounts Yes No
· Current bank statement Yes No
· Details of authorised signatories to the account Yes No
· Compliance with the National Protection of Vulnerable Groups
Scheme
Project
· Evidence of security of tenure of project site Yes No
Owned sites require copy of title deed documentation and
solicitor’s letter confirming ownership. Leased sites require
copy of fully-signed lease, rental or access agreement
· Management or access agreements Yes No
· Accommodation schedules Yes No
· Photos of existing site Yes No
· Site plan or location plan Yes No
· Planning Permission in Principle or Full Yes No
· Dimensioned design drawings/sketch proposals Yes No
· Stamped approved drawings Yes No
· Quotation or estimates Yes No
· Outline specification of works Yes No
· BCIS specification of works Yes No
· Detailed programme of use Yes No
If any of the above documentation has not been submitted please outline the reason(s) for this below:
CONDITIONS OF GRANT
I have read and noted the Conditions of Grants which were issued along with the Application Form and Guidance Notes for the Community Facilities Grant. I confirm that our organisation is in a position to adhere to these conditions and understand that this is an agreement between this organisation and Inverclyde Council.
If our grant is successful, we will sign and return the Conditions of Grant immediately to allow payment to be made.
To the best of my knowledge and belief, all the information we have given in this application is true and correct.
Name / Position in the groupSigned / Date
Section 8: Not to be completed by applicant
(for internal use only)
Date E-mail/Application Received:Date Application checked for enclosures
Date Application checked for eligibility
Officer Recommendation:
:
Date of Approval/Rejection:
Page 2 of 9