INDIVIDUAL AWARDS
FOR PEOPLE WITH DEMENTIA AND
PEOPLE CARING FOR SOMEONE WITH DEMENTIA
2016 to 2018
Life Changes Trust
Open Call for Delivery Partners:
Aberdeen
Angus
Lochaber, Skye & Lochalsh
APPLICATION FORM
April 2016
- Completing and returning the form
- Do not fill out this form or the accompanying budget spreadsheet until you have read the Guidance for Applicants. You are strongly advised to also read the other documents cited in the Guidance.
- Please fill in the form and the budget spreadsheet electronically.
- You must complete every section of the form and the budget spreadsheet.
- If your application is on behalf of a consortium, the lead organisation for the consortium mustcomplete and sign the form.
- If you wish to apply to be a delivery partner for Argyll & Bute and/or Edinburgh, you should refer to the separate Guidance and complete the application form for these areas. We will only consider applications for those two areas on that form.
- If you have any questions, please contactElizabeth Morrison, Programme and Funding Manager, People Affected by Dementia
Telephone: 0141 212 9617
Email:
- Submit your application by email only.
- Email your application to th the subject header ‘Individual Awards 2016-2018 - Application’.
- Completed forms must be received no later than Friday 1 July 2016.
- Please include the name of your organisation on all supporting documents attached.
- Please name each individual attachment e.g. application form, finances, supporting letter from X, etc.
- It is your responsibility to make sure that your application form reaches the Life Changes Trust. The Trust cannot accept responsibility for forms which do not arrive by email and do not arrive by the above deadline.
- Main contact - your details
This is the person you want the Trust to contact regarding your application.
If you are completing this application on behalf of a group of organisations (a consortium), your main contact must be from the lead partner organisation.
2.1Please tell us your full name:
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2.2Your organisation:
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2.3Your position or role within that organisation:
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2.4Your telephone number:
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2.5Your email:
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2.6Your organisation’s address:
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2.7Your organisation’s postcode:
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2.8Please specify the legal status of your organisation (e.g. registered charity) and provide registration details as appropriate (e.g. charity number).
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2.9Does your organisation have a website?
Yes☐
No☐
2.10If yes, please provide the address.
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3Consortium application only
If you are making an application on behalf of a single organisation, go straight to Section 4.
Applications must be completed by the lead partner.
3.1If you are completing this application on behalf of agroup of organisations (a consortium), please name theconsortium.
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3.2Give the name of allthe organisations involved and their legal status.
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4The area/s where you are applying to deliver Individual Awards
Both people with dementia and people caring for someone with dementia, unpaid, for more than four hours a week, and living in the specified areas will be eligible to apply for an Individual Award.
4.1Please indicate the area or area/s where you wish to administer Individual Awards.
AREA / YES / NOAberdeen
Angus
Lochaber, Skye & Lochalsh
4.2Please confirm if you are also applying to be a delivery partner for either of the other two areas.
AREA / YES / NOArgyll & Bute
Edinburgh
4.3If yes, please confirm that you have completed the separate application form.
Yes☐
No☐
5The amount of funding you are applying for
Delivery partner support costs - you may apply for funding to cover the costs you will incur in delivering Individual Awards in your area/s.
5.1Please indicate the total amount you are applying for, also showing how much by year and by area, if applicable.
Later in the application you will be asked to provide us with a full breakdown of your costs. See Section 9.
Area/s where you are applying to deliver Individual Awards / Year 1Oct 2016 to Sept 2017
(12 months) / Year 2
Oct 2017 to Aug 2018
(11 months) / Total
£ / £ / £
Total
5.2Please confirm if your organisation/consortium is able to make an in-kind contribution to support this work.
Yes☐
No☐
5.6If yes, please provide details.
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6Commitment of your organisation/consortium
Your application must have the support of your organisation at a senior level.
6.1Is your organisation’s Senior Management Team and Board in support of your application?
Yes☐
No☐
6.2Have you included a signedsupporting statement on your organisation’s letterhead from your CEO or someone of equivalent seniority?
Yes☐
No☐
If you are applying on behalf of a group of organisations, with your application, you must also provide signed supporting statements from every organisation involved onletterhead.
6.3Are statements from all the partners included with your application?
Yes☐
No☐
A scanned, emailed version of statements is acceptable.
7Your approach to delivering the Individual Awards Scheme
7.1Please explain how you wish to carry out the role of delivery partner (continue onto further pages if necessary).
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8Your suitability for the role of delivery partner
As per Section 7 of the Applicant Guidance, please demonstrate how you meet each of the following requirements.
8.1Your knowledge, skills and experience – how your organisation/your consortium partners work/s with people living with dementia and people caring for someone with dementia to promote their quality of life, well-being, inclusion and empowerment.
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8.2How you will support people living with dementia and carers to maximise the benefit from their Award, whilst enabling them to decide themselves what they want to apply for.
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8.3What your knowledge is of your geographical area including demographics, as well as services, amenities and resources available locally.
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8.4How you will ensure the voice and participation of people with dementia and people caring for someone with dementia are an integral part of your Individual Awards system and processes, for example, involvement in the assessment of applications and Award decision-making.
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8.5How you will effectively plan, structure and operate a system to administer Individual Awards in your local area in a way which achieves the above and provides a positive experience for people with dementia and carers.
‘Administration’ includes all stages of the Award process, including local promotion of the Scheme; support and facilitation to individuals at pre-application, application and post-application stages including support to spend the Award if needed; assessment; Award panel decision-making; payments; and collection of receipts and feedback from all Awardees.
Robust monitoring and control of expenditure to prevent the Individual Awards Scheme becoming over-extended will be an important component of effective Scheme management. Interim, bi-monthly financial updates on Individual Awards expenditure will be required.
A clear and secure coding system, used consistently, for applications, applicants and Awardees will be important to ensure people’s confidentiality throughout and to allow clear and anonymous linking of data at the evaluation stage.
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8.6How you understand effective partnership working and how you will anticipate working in collaboration with Care and Repair in the context of the Individual Awards Scheme.
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8.7How you understand equality issues and, reflecting the demographic composition of your area/s, how you will use this opportunity to reach a diversity of Awardees.
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8.8Your understanding and procedures for the protection of vulnerable groups and adult support and protection.
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9Finances - your delivery partner support costs in detail
With your application form you must submit a detailed breakdown of how Life Changes Trust funding would be spent.
Please refer to the Guidance for Applicants and complete the accompanying budget spreadsheet. We will only consider applications with this spreadsheet attached.
The budget spreadsheet contains 2 sheets. Use the first to show your costs relating to direct support to people with dementia and carers throughout the Individual Award process. Use the second to show your costs for administering the monies which delivery partners will distribute as Individual Awards to beneficiaries.
9.1Have you included the completed budget spreadsheet with your application?
Yes☐
No☐
9.2Please explain how you have calculated your costs, including any contribution to your overhead costs which should be reasonable and proportionate.
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9.3If VAT is applicable to any of your costs, please confirm which specific costs.
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10Evaluation
The Life Changes Trust believes that evaluation of the initiatives it funds is crucial for turning knowledge and learning into action.
10.1Please indicate that you understand the importance of evaluatingtheIndividual Awards Scheme and that your organisation/consortium will participate in review and evaluation processes put in place by the Trust.
Yes, we will☐
No, we will not☐
11Commitment to collective learning
The Trust expects theIndividual Awards delivery partners it funds to be committed to building relationships with each other, and with Care and Repair, in order to learn from each other. This will require interaction between delivery partners and a genuine willingness to share learning.
11.1Please indicate whether or not your organisation/consortium is committed to this collective learning.
Yes, we are committed☐
No, we are not committed☐
12Declaration
Please sign this Declarationonly if you agree with the statements below.
a)I have authority to complete and submit this application form and accompanying budget sheet;
and
b)All of the information provided in support of this application is, to the best of my knowledge, accurate;
and
c)I understand that the Life Changes Trust may contact me to ask for further information or clarification regarding this application.
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Signed:______
An electronic signature is acceptable when the application is sent from the named person’s email address.
DateClick here to enter text.
The Life Changes Trust will contact you no later than Friday 19 August 2016 to let you know whether or not your application has been successful.
Life Changes Trust – Individual Awards Phase 2 – 2016 to 2018
Delivery Partners Open Call: Aberdeen; Angus; Lochaber, Skye & Lochalsh
APPLICATION FORMFINAL – for issue 11 Apr 2016
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