Western Bay
ICF Third Sector Large Grant Scheme
Application form – plain text version
Please read the Background and GuidanceInformation before completing this form.
If you have any communication needs or require this information in a different format please contact your local CVC. A screen reader accessible version (plain text) and a
Welsh version of the form and guidance is available on your local CVC website.
Completed forms should be emailed to by no later than 5pm, Friday 16thMarch 2018.For any queries, please contact Nicola Trotman at or 01792 636946.
To be eligible to apply, the organisation must:
Be a third sector organisation with an acceptable governing document (confirming it is non-profit distributing), based in either the City and County of Swansea, or the Counties of Neath Port Talbot or Bridgend (or represent, provide services or support residents in these counties)
Have a bank account in its name requiring at least two unrelated signatures to authorise withdrawals
Provide a set of their most recent financialaccounts and have in place (or be actively working towards) the following policies: Safeguarding, Equality and diversity, Sustainability or environmental, Welsh Language
Be able to deliver the project between 1st April 2018 and 31st March 2019
Be applying for funds towards a project which meets one or more of each of the principles and prioritiesfrom the lists below.
The following principles include Western Bay’s Integrated Care Fund objectives. Your work must be supportive of one or more of these principles below.
Integration – partnership working and co-operation
Prevention and early intervention
Alternative delivery methods
Wellbeing for people who need care and support
The following list details the Western Bay Area Plan priorities which also reflect the Integrated Care Fund (ICF) priorities, as outlined in the Welsh Government guidance. Your project must meet one or more of these priorities.
Older people with complex needs and long term conditions, including dementia and supporting pressures on early hospital discharge/reablement.
People with learning disabilities
Children with complex needs due to disability or illness (including mental health and emotional health problems.
All carers, including young carers
People with mental health problems
People with autism
Please ensure that your organisation is eligiblebased on the information above and in the Background and Guidance Information before applying.
If you need help or require an alternative format, please contact your local CVC.
- Project Description
Please write no more than 300 words for any individual question
a)What is the name of your project?
b)Where will it take place? Bridgend, Neath Port Talbot, or Swansea
c)What do you hope to achieve with the grant?
d)Can your project be delivered between 1st April 2018 and 31st March 2019? Yes or No
e)What you will do and when? What is the expected number of beneficiaries?
f)Please briefly describe how your project:
- Addresses one or more of the priorities
- Will work in support of one or more of the principles
g)Please list up to six positive changes which you hope to see as a result of your project:
h)How will you monitor and evaluate your work?
i)What evidence do you have that there is a need and support for this activity?
j)How will you ensure that the project is open and safely available to everyone in your target audience?
k)Will services be available through the Welsh Language?
Face to FaceYes or No
Written informationYes or No
Electronic InformationYes or No
If the answer for any of the above is No, please state the reason below:
- Project Costs
a) Item of ExpenditureCost £
Total Project Cost
Total Grant Requested
Costs covered from other sources
If you have indicated that any costs will be covered by other sources, please provide details below:
SourceAmountConfirmedRestricted
c) If we are unable to provide the amount you have requested, would you be able to deliver the project with reduced funding?
Yes or No
d) What plans do you have for the sustainability of the project beyond the end of any funding awarded?
e) Can VAT be reclaimed on your project costs? Yes or No
If yes, please state your VAT registration number:
Please note that if you are VAT registered then VAT will be non-claimable through this grant. If you are not VAT registered then please ensure that costs are inclusive of VAT.
- Organisation details
a)Name of organisation
Contact name for application
Position in organisation
Address
Telephone
Website
Alternative contact for application
Position in organisation
Please note this person is also required to sign the form
b)When was the group established?
c)Is the organisation registered as a Charity, CIO, CIC or company? Yes or No
If yes, please provide the relevant registration numbers here
d)How many people work with your organisation?
Trustees, Board Members or Committee Members
Volunteers
Members
Beneficiaries (approximately)
Paid Staff
e)Which area or areas does your organisation work in?
Bridgend, Neath Port Talbot or Swansea
Declaration
I confirm on behalf of my group that I am authorised to sign this declaration and that to the best of my knowledge all information within this application is accurate. As a group, we hold the required consents, insurances, safeguarding measures, ownership/leasing documents in order to carry out the activities stated in this application.
I understand that the grant must be spent for the purpose for which it is awarded and within the given timeframe otherwise it may be subject to repayment in part or in whole.
I understand that the panel’s decision is final and there is no appeals process. I understand that SCVS (for the administration of this scheme) may collect further information in support of this application at any stage of the process and that any offer is made on the basis of agreement with the terms and conditions provided at the offer stage.
By submitting this application form, I give consent to the information being kept on file for administration and monitoring purposes for the duration of the grant process.
I understand that the organisation’s contact information in Question 3 a will be held in a database of voluntary organisations by our local CVC and may be made publicly available as a sector directory. Details are occasionally shared but personal contact details will not be published.
Please tick if you would like these details to be for internal CVC use only i.e. mailings If someone else is a preferred contact please include their details on a separate sheet.
Signature of main contact
Date
Signature of alternative contact
Date
Completed forms and additional information requested should be emailed to by no later than 5pm, Friday 16th March 2018.
Use this checklist to ensure you are sending a complete application
All questions have been answered
The application form has been signed by two people
A copy of the application form has been kept for future reference
You have enclosed:
Copy of signed constitution/governing document/rules
Copy of Equality and Diversity policy
Copy of Welsh Language Policy
Copy of sustainability environmental policy
Copy of safeguarding policies - if appropriate for the project
Latest signed Annual Accounts - or, for new groups, an Income & Expenditure forecast
Copy of bank or building society statement not more than 3 months old
Copy of quotes or estimates
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