LARGE PROJECTS Ref:WF/

APPLICATION FORM 2016/17 (for Prospects use only)

Please make sure you have read the guidance notes before filling in this form so that you have all the information you need to hand to avoid leaving out essential details.

Use this form if you are applying for a grant of more than £2,000

Fill in all sections of the form and submit it with all required accompanying documentation.

You can print the form and fill it in by hand or download the form and type in your responses. If you fill it in by hand please continue on separate pages if necessary as there may not be enough room to fit everything into the boxes provided. If you are using a computer to fill in the boxes then they will expand as you type and it also means that you can return it to us by email.

Keep a copy of this form as you may need to refer to it if we have any questions regarding your application during the assessment process.

1. Contact Details
a. Full name of organisation
b. Name of main contact
c. Address of main contact
(this is where all correspondence
will be sent unless otherwise
specified)
d. Position in organisation
e. Daytime telephone number
f. Out of hours telephone number
g. Email address
h. Organisation’s website
2. Group Details
a. What type of organisation are
you?
(eg community group, social
enterprise, co-operative etc)
Please state charity number/
Company registration number if
applicable
b. What sort of governing
document do you have?
c. How many people are on your
governing board/management
committee?
Do you have a Chairperson
and a Treasurer?
d. Please provide the details of
your organisation’s
bank account
(the grant will be paid by BACS
transfer into this account. We will
not make payments to individuals) / Account name
Name of bank
Address of Bank
Account number
Sort code
e. Has your organisation
got all the policies, procedures
and insurance relevant to it’s
activities?
Please tick the boxes to show
which policies you have in place
(and list any others not shown) / Health & Safety
Equality & Diversity
Safeguarding Children
Safeguarding Adults
Public Liability Insurance
f. What does your organisation do
and who does it work with?
g. Has your Group carried out
environmental projects before?
Please specify
h. Has your group applied to the
Windfall Fund before? / Yes No
What was the outcome of your
application?
If you were successful, please
give date awarded, amount and
ref. number
3. Project Details
a. Name of project
b. Which environmental
sustainability theme does
your project fall within?
(please tick at least one relevant
theme) / Biodiversity & wildlife habitats
Waste minimisation & recycling
Energy conservation & renewables
Sustainable transport
Local food
Raising environmental awareness
c. Please give a detailed description of your proposed project and
include an explanation of how your project will contribute to
environmental sustainability for the theme specified
Maximum 1,000 words. (please continue on separate sheet if necessary)
Please enclose maps, plans and photos, if applicable, to fully
illustrate your proposals.
d.Why is this project needed/What are the issues and difficulties
being addressed by this project?
e. What overall outcomes will be achieved as a result of this project?
f. How does your proposal fit into the wider strategic context of
environmental sustainability in Hyndburn?
eg. refer to priorities in the local Biodiversity Action Plan/
Sustainable Community Strategy etc.
g. How do you intend to
incorporate sustainable practices
into the delivery of your
project?
h. Give details of any organisations
consulted as part of your project
development
i. Where will the project take
place?
(please give grid reference)
j. Do you own the land/premises
where the
project will take place? / Yes No
If not, please tell us who does
(you will need to submit a letter
from the landowner/landlord
confirmingpermission to use the
land/building)
Is there a management plan in
place for the land? / Yes No
k. Is planning permission or any
other consent required in order
for your project to go ahead?
If yes, please give details
l. When will the project take
place? / Start date / End date
Please identify key stages in the project delivery.
m. Please give details of any
partner organisations who will
be involved in the delivery of
the project
n. How many people will benefit
from the project
-as volunteers involved in the delivery
-as beneficiaries
o. If you are purchasing
equipment, please tell us where
it will be stored
p. How do you know that people
in your community want/support
this project?
q. At the end of the project how
will you measure the project’s
success against the intended
outcomes?
r. Please describe the
arrangements you will put in
place for the continued
maintenance and upkeep of the
completed project
s. How do you propose to promote
environmental awareness
through your project?
4. Project Costs
a. What is the TOTAL cost of your
project?
b. How much are you
requesting from the Windfall
Fund in total?
Grant payments may be staged,
Please indicate how might you
like the payments to be
staged?
(minimum £2,000) / Total Amount Requested / £
Suggested staging of grant payments:
Amount/ £ / Date
c. Where is the rest of the funding
coming from?
Give a full breakdown of the cash funding being contributed to the project from all sources and confirm the status of the match funding eg approved/applied for
d. Please itemise a list of
everything you intend to spend
on your project using the
budget headings in the guidance
notes as a guide
(written estimates are required
for any individual item costing
more than £250)
Item or Activity / Total Cost / £ / Amount Requested from the Windfall Fund (£)
Total / £ / £ / £
e. Please identify and put a value
against any volunteer time or in-
kind contributions that are being
contributed to the project / In-kind/volunteer time contribution / Value/£
Total / £ / £
f. Is your organisation registered
for VAT? / Yes No
5. Declaration
I certify that the information provided is accurate and true. I confirm I am authorised to apply for this funding on behalf of my organisation.
I understand that if it becomes evident that any of the information I provided was misleading then PROSPECTS Foundation reserves the right to withdraw any offer of funding/reclaim any funding that has already been given. / Name
Position in organisation
Date
6. Checklist
You must enclose the following information, if applicable, when you submit your application form. / Please tick
a. Constitution/set of rules/governing document
b. Annual accounts/statement of income/expenditure AND a
copy of your most recent bank statement
c. Maps, plans, photos etc
d. Copy of permissions/consents/management plans etc.
e. Evidence of support of the local community
f. Written estimates for any individual item costing > £250
g. Evidence of funding being contributed to the project from
all sources
h. Letter of approval from landowner/landlord

Closing dates for receipt of applications are as follows:

Friday 16 December 2016 at 12 noon

Friday 03March 2017 at 12 noon

Friday 16 June 2017 at 12 noon

Friday 01 September 2017 at 12 noon

If at all possible please email your application form along with all the supporting information to:

Or post/hand-deliver this form along with the supporting information required to:

Alison Silver

Windfall Fund Co-ordinator

PROSPECTS Foundation

PROSPECTS Environment Centre

54 Broadway

Accrington

BB5 1EW

Tel: 01254 230348

Remember to put the correct postage on your envelope. Incorrect postage may mean a delay in receiving your application or it may not arrive at all.

Large Projects Application Form – 2016/2017 version Page 1 of 9