Ealing Grants Commissioning

Application Form for Grant Aid

Application Form 1st October 2015 - 31st March 2019

Closing date for Applications: Thursday 4th June 2015

The application form and documents attached will be available for public inspection.

(Please note late applications will not be considered)

(All applications forms must be typed).

Please read our application guidelines carefully before completing this form and ensure all parts of the form are completed fully and that you have enclosed all the required documents.

Please read the grants criteria carefully to ensure that your organisation and service meets the identified need, criteria and service outcomes. For copies of any strategies referred to please see www.ealing.gov.uk

If you have any queries about the application form, application process or grant criteria, please contact the appropriate Officer below:

Adult Services contact: Surinder Jassal ()

Children’s Services contact: Danielle Grant-Vest () or Maggie Wilson ( )

Community Grants contact: Nigel Fogg () or Delores Graham ()

Public Health contact: Jackie Chin () or Tanvi Barreto ()

If you need any help in completing your application you can contact any of the following Funding workers:

Ealing CVS Funding Manager: Antony Bewick-Smith

Community Funding Officer: Suki Kaur ( )

Completed application forms and other required documents should be sent to (preferably by e-mail):

If you are sending in a hard copy please send it to:

Delores Graham

Grants Unit

Ealing Council

Perceval House

14-16 Uxbridge Road

London

W5 2HL

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Name of Organisation:

Which Grant Areas are you applying under

(tick all that are appropriate)

Community

Volunteer Support and VCS Development

Area Activities that promote Neighbourhood and community development

Adults

Information, Advice and Customer Representation Service

Carers Respite Support

Being part of the Community

Support Planning and Brokerage

Self-Care Service

Counselling Service

Children

Young Carers

Children’s Voluntary Sector Safeguarding

Domestic Violence – Children and young people and parenting support

Children with Disabilities – Information, advice and support services for parents/carers

Children with Disabilities – Short Breaks

Information, advice and support services for families experiencing disadvantage or specific difficulties

Public Health

Mental Health Promotion

Improving Services of older people – (A) Social isolation in older people, (jointly funded with Adults Services) and (B) Improving the strength and balance of older people.

Programme to help people make healthy choices, live healthy lifestyles and reduce health inequalities.

Part A

For consortia bids the LEAD organisation must complete Part A

Your organisation

1) Name of Organisation:

2) Date your organisation started:

3) Name of Contact Person:

Tel Email

4) Address for Correspondence

Address:
Email:
Telephone:
Ealing address if different:
Email:
Telephone:
Web address:

5) The legal status of your organisation

Company limited by Guarantee Registration No:

Registered Charity Registration No:

Registered Social Landlord Registration No:

Voluntary Organisation

Social Enterprise / Community Interest Company Registration No:

Friendly Society Registration No:

Other (please describe):

Is this a branch or subsidiary of a larger or national organisation?

Yes / No

If yes please describe:

Are you part of a federal organisation?

Yes / No

If yes please describe:

6) Management Committee

Name of Chair of the Management Committee:

Address for Correspondence:
Email:
Telephone:

Please give details of any Councillors or Council Officers that are members of your management committee

7) Policy and Procedures:

Please submit copies of your following policies and procedures with your application form.

Copies of your policies and procedures need to be sent in to us once, although you may be applying for more than one grant criteria.

Constitution / Governing Document

Safeguarding Children (for all Children’s Services)

Name of Designated Safeguarding Children Advisor:
Position in Organisation:
Contact No:
Email:

Safeguarding Adults

Equal Opportunities Policy

Health and Safety

Registration No with appropriate body/ies i.e. OfSTEAD, CQC (if applicable)

Complaints Procedure

If this is a Consortia application, please submit a Signed Statement of Intent to be signed by all consortia members.

Please note that some grant criteria require details of additional policies, procedures and documents. Please read the criteria carefully and enclose any required documentation with your application.

8) Organisations Aims and Objectives

Please provide an outline of your Organisation’s overall aims and objectives

Maximum of 200 words

9) Organisations Services

Please provide a brief outline of the key services currently provided by your organisation (including partner organisations, if a consortia bid).

Maximum 300 words

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10) Assessing Social Value

What additional social value benefits do you envisage your service delivery creating?

Maximum 100 words

What specific benefits will there be in terms of:

· Employment of local people

· Employment for people with disabilities

· New apprenticeships for local unemployed young people

· New volunteering opportunities for local people

· Building wider community capacity and skills

Maximum 300 words

What are your current activities in Ealing?

Maximum 100 words

What is your understanding of the needs of service users and residents in Ealing?

Maximum 300 words

Part B

Information about the service you wish to provide. This is the most important part of the application form.

Please ensure that you complete all the questions within the form and that you submit a Service Development Plan.

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1) Amount of funding applying for

(Please note the level of funding available for each year may be different. Please refer to the Grant Criteria for details. You should take this into account in your application)

Year 1 £ 1/10/15 – 31/03/16

Year 2 £ 01/04/16 – 31/03/17

Year 3 £ 01/04/17 – 31/03/18

Year 4 £ 01/04/18 – 31/03/19

2) Is this a Consortium Bid?

The Council will consider bids by consortia. For consortia bids there must be a lead organisation that will be responsible for the overall delivery of the service, and be accountable for the conditions of grant, making payments to partners, accounting for all funds and completing monitoring forms and other information requests. We also require a signed Statement of Intent from all the partners of the consortium, setting out: (a) the lead body (b) policy and procedures of the lead body, (c) the role of each partner in the delivery of the service (d) that the consortium members have agreed to co-operate in making the application, and (e) details of the arrangements the consortium members intend to have for the purpose of the grant, e.g. will it be a partnership, a joint venture or is the intention to form a new company.

A signed consortium agreement will be required before any grant is made.

Yes No

If Yes

Name of lead organisation

List all partner organisations of the consortium

Note:

· We only need supporting documents from the lead organisation (e.g governing documents, complaints procedures etc, not from all the partner organisations)

· The service development plan should identify clearly roles and funding for each partner organisation

Service Details

3) Is this service

New / Existing

3a) If existing how is it currently funded:

Maximum 200 words

3b) If you do not currently receive Ealing Council funding please describe your start up costs and how these will be funded (the Council will not provide or fund additional start up costs)

Maximum 100 words

3c) If it is a new service please state the date when the service will be fully operational

Maximum 100 words

4) Evidence of need.

Please provide evidence of need for the service / activities that you are proposing to provide. How does this proposal address any specific needs of service users in Ealing including the needs of “equality groups”. (A list of equality groups can be found in the Guidance Notes)

Maximum 500 words

5) How the Service will operate

Please describe how the service will operate covering:

(a) An outline of the activities / services for which you are requesting funding

(b) How these meet the grants criteria and

Maximum 1000 words

6) The organisations experience of delivering these services

Please set out below

(a) The organisation’s “track record” in delivering these activities / services.

(b) The capacity and resources (eg premises, equipment etc) you have to offer

(d) Your approach to quality assurance (outline any quality assurance measures you have including accredited qualifications or working towards)

(e) Your approach to participation and consultation methods with service users and how this influences service development/delivery,

(f) Your approach to the supervision and monitoring of staff and volunteers

(g) Please describe how you will use volunteers in delivering your service and how many new volunteers you will recruit

(h) Your approach to Supported Volunteering where volunteers receive additional support in order to carry out their volunteer roles.

Maximum 1500 words

7) Working with other organisations

Please describe (a) your organisations experience of working in partnership with other organisations to deliver services; and

Maximum 500 words

(b) how will you work with other organisations to deliver the proposed services.

Maximum 500 words

8) Location of proposed service

Please state (a) where the activities / services will be located in the Borough and

(b) Which geographical areas will be served?

Acton

Ealing

West Ealing

Hanwell

Northolt

Greenford

Perivale

Southall

Borough wide

9) Frequency/ availability of the Service. Please state timing and frequency of services/ activities over a 7 day period

Maximum 100 words

10) Please identify, where appropriate, your signposting and referral processes and policies.

Maximum 200 words

11) Number of Beneficiaries Please state how many individuals you intend to support (per annum) and how the number is worked out.

Number overall per annum:

Maximum 100 words

How have you estimated the number of beneficiaries?

Maximum 300 words

12a) Please describe the profile of your proposed service users. Please use the tables below to show your estimated users.

Aged Between / Percentage of clients
Male / Female
0 – 4
5 – 11
12 – 18
19 – 24
25 – 60
Aged 60+
Disability / Percentage of Clients
Learning disability
Physical Disability
Mental Health
Other Details of Beneficiaries / Percentage of Clients
low income, unemployed or living with poverty
lone parents
Lesbian Gay Bisexual Transgender (LGBT)
Ethnicity (Main Category) / Ethnicity (extended codes) / Percentage of clients
Asian or Asian British / Bangladeshi
Indian
African Asian
Other Asian
Pakistani
Black or Black British / Other Black African
Ghanian
Nigerian
Somali
Caribbean
Any Other Black Background
Other Ethnic Heritage / Chinese
Afghan
Arab Other
Iranian
Iraqi
Japanese
Latin/South/Central American
Any Other Ethnic Group
Mixed / Dual Background / Other Mixed Background
White and Asian
White and Black African
White and Black Caribbean
White / White British
White Irish
Traveller of Irish Heritage
White Eastern European
White Other
White Western European
Gypsy/Roma

12b) Are you intending to target the new service to specific cohorts of the community. If so who are you targeting, please explain why and how you will do this?

Maximum 500 words

13a) Meeting the needs of equality groups. (For a list of the equality groups please see the Guidance Notes which accompanies this form.) Please give two examples of how you ensure equal opportunities and equal access for users, staff and volunteers.

Maximum 200 words each

13b) How will you ensure information will be communicated effectively and take into account the needs of people accessing the service.

Maximum 500 words

13c) Equalities / Community Cohesion: Please describe what actions you will take to promote equality, diversity, social inclusion, community cohesion and sustainability.

Maximum 500 words

14) Service Development Plan (SDP).

All organisations must submit with their application a service development plan covering the funding period (ie 2015 – 2019. It is open to applicants to develop the format for this and it can be set out in tabular form. If the application is from a consortium the service development plan should identify clearly roles and funding for each partner organisation. The SDP must include relevant information regarding the grant criteria on:

· Outputs, milestones and outcomes for each key activity or service for each grant criteria applied for in each year;

· If these vary each year, for example due to a reduction in funding, the impact on service users, particularly for disadvantaged equality groups;

· How outputs and outcomes will be measured;

· An assessment and identification of risk (high, low and medium) relating to the capacity and sustainability in maintaining the activities and services and how you will mitigate them in delivering the services and activities.

Outputs should be sufficiently detailed regarding the components of the services. For example, if you are running an advice service, you should include outputs for enquiries, advice and casework for each advice category e,g, debt, welfare benefits, housing etc.

If you are applying for more than one grant criteria then, please include all the relevant information on each criteria you are applying for in one Service Development Plan.

Information and guidance on outputs, milestones, outcomes and risk and how to measure these is available from the funding Workers as shown at the start of the application form.

15) How will you achieve and demonstrate value for money?

Maximum 300 words

16) BUDGET

(Please note level of funding for each year may be different due to reductions in grant budgets. You should take this into account in your application)

A) INCOME

Please list all sources of income for the services/activities you are applying for and indicate whether it is committed / probable or anticipated with C, P or A after the figure

Source
£ / Amount £
1/10/15 to 31/3/16 / Amount £
1/4/16 to 31/3/17 / Amount £
1/4/17 to 31/3/18
LBE Grants
Government Grant
Trusts
Fundraising
In-kind
Other
TOTAL / £