Application form

for Voluntary, Community and Social Enterprise Groups

or Town or Parish Councils

1Application details

1.1Organisation name and registered address:

1.2Project name:

1.3Please indicate which of the following apply to your organisation:

Registered and pre-approved with the Council’s on-line system
Registered Charity number (if applicable)
Town or Parish Council
None of the above

2Project purpose

2.1Provide a concise description of the purpose of your project, detailing what it will achieve and how it will benefit your community. What is the evidence of need for your proposal and which groups will benefit (egprotected characteristic groups)?

2.2How will you ensure people with different requirements can participate in the project and have continuing access?

2.3Where will the project take place?

2.4Planned project start date: ../../..Planned project end date: ../../..

2.5How many residents will benefit from your project?

2.6Which wards do they live in?

3Funding

3.1Full cost of project£ 0.00

3.2If you have raised other funds towards your project please list sources and amounts

Source of funds / Amount £
Total other funding / 0.00

3.3In the table below, detail the items you will spend a Member Award on

Item / Expenditure £
Total Member Award requested / 0.00

3.4Give the year and amount of any funding your organisation has received in the last 3 years from South Gloucestershire Council.

Year / Amount £ / Name/type of funding

4Strategic value

4.1Indicate whichof the Council’s priorities and aims relate to your project

Council priorities(People/Place/Resources) / Aim

5Permissions and Insurance policies

5.1What external permissions are required for your project? eg planning permission.

5.2Have these been granted? Yes/No/NA

5.3Will your project require any of the following insurance policies? Please indicate all that apply.

Buildings and contents / Employers’ liability
Public liability / Professional indemnity
Other (please specify)

6Member details

6.1Please name all Ward Member(s) that you have discussed your proposed project with and that you are requesting a Member Award from.

7Declaration

I confirm that:

I am authorised to sign on behalf of the above named organisation and that any funding will not benefit any individual or private business more than the local community generally and will only be used for the purposes specified in the application.

I will keep appropriate financial records and equalities data records in order to evidence project expenditure and how the funding has benefited the local community and will notify the Council’s Grants Team once project expenditure has been concluded.

I declare that, to the best of my knowledge, all statements and representations made in connection with the data are true, accurate and correct.

Your name:Position:

Email address:Date:

Version1 October 2016