Keith Owen 1938 – 2007

Application for a

Keith Owen Fund Award

Please read Notes for Applicants before completing form in boxes marked *.

1 Organisation/Group making the application

Name of Organisation / Group / *
Is it a registered charity / Yes / No / If yes, give number*
Is it registered for V.A.T / Yes / No / If yes, give number*

2Contact details (we will contact you by email where possible)

Name of contact / *
Address
*
Telephone Number / *
Email (please print) / *
Position in Organisation / group (e.g. Chair, Secretary ) / *
Do you or anyone in the organisation have any personal / financial interests in this project
No / Yes (details)*

3 About the Project

Name of project / proposal / *
Brief Description of project / proposal (150 words max)
*
Has the consent of the land-owner and / or planning consent been obtained / Yes / no / na*
Who will benefit from the project (e.g. numbers, age groups)
*
Number of volunteers likely to be involved and in what capacity
*
If KOF application is successful what is the anticipated start date / *
and completion date / *
Does the organisation have previous experience with a similar project / No / Yes (brief details)
*

4 About the Finances

What is the anticipated total cost of the project / *
How is this figure calculated (enclose quotes / estimates)
*
What funds do you already have towards these costs / *
Are you applying to others for other grants / awards, if so: from where, and for how much?
*
Amount of money are you applying for from KOF / *
After the project is completed, how will any ongoing costs be met
*
Have you included a copy of your latest accounts / *Yes / No

5 How you heard about the Keith Owen Fund

Please say how you heard about the fund by ticking from the list below
Local Paper / SVA Newsletter / SVA website / Word of mouth / Other

6 Declaration

I/we wish to apply for an award from the SVA Keith Owen Fund and confirm all the answers and information given are true.

Signed …………………………………………………………………………..

Failure to give accurate or full information, or to declare any personal interests, or double funding, or use of an award for different purposes may result in a withdrawal of the application or a request for repayment of any awards already made.

The completed application (and accounts) should be posted to

The Secretary, KOF Grants Committee, 43 Primley Road, Sidmouth EX10 9LF

(tel 01395 576998)

or emailed to (pdf format with signature preferred but see checklist below)

Please do not staple or bind papers as they will be scanned for distribution.

CHECKLIST

  • All boxes completed on application form
  • Declaration signed (if submitting form by emailwithout a signature then also post hard copy with signature)
  • Accounts enclosed/attached
  • Estimates/quotes enclosed/attached

June 2016