Grant Aid to Community Organisations 2012/2013

Application Form for One-Off Grant Aid

Please read the guidance notes with this form. For assistance with completing this form you can attend one of the meetings detailed in the enclosed letter. Use this application to apply for grant aid under either the Small Grant Programme or Faith and Social Action Programme. Please tick only one box below to indicate under which grant programme you are applying:

Faith and Social Action Programme  Small Grant Programme 

Answer all questions on this form. Do not refer us to your annual reports, annual accounts, constitution or other printed material.

Please return this form as soon as possible and no later than:

12 noon, Wednesday8thAugust 2012

Return to: Community Sector Unit,
2nd Floor, Laurence House
Catford Road
London SE6 4RU
Tel: (020) 8314 7855 or 6730
Email:

Amount Applied For*:

* Maximum grant available for individual project, £2,500 and for inter-organisational partnership projects, £6,000.

Details of your organisation & of your partner(s) if applicable

1. / Name of your organisation and, if applicable, your partner organisation(s):
2. / Address and ward where your organisation(s) is/are based:
Address: Ward:
3. / Name of contact person(s):
4. / Daytime Tel: / Mobile Tel:
Fax: / Email address:
5. / Address where official correspondence should be sent if different from 2 above:
6. / Wards where activities are carried out:(please list wards your activities cover. If all Lewisham, put borough-wide).
7. / Approximate percentage of the work carried out in Lewisham: / %
8. / Address where the organisation’s activities are carried out:
Address of Property / Name & Address of Owners / Yearly Rent / Date Lease Expires
9. /
When did your organisation start?
10. / What is the legal status of your organisation? (tick those that apply)

Unregistered organisation
Registered Charity Charity no:
CompanyLimited by guarantee Company registration no:
Other – please specify (quote reference number)
11. /
Please give a brief description of your organisation(s)
12. /
How do people find out about your organisation(s)?
13. /
How do you work with similar services or activities provided by other voluntary organisations or by the council?
14. / Public opening hours
Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
15. / How many people are involved in your organisation(s)?
/ Committee members Other members Paid staff Volunteers
16. / Please complete the equalities profile for your management committee, staff and volunteers
Key / M: Male / F: Female / D: Disabled / P: over 55s / G/L/B/T: Gay/Lesbian/Bi-Sexual/Transgender
Management Committee /
Staff
/ Regular Volunteers
M / F / D / P / GLBT / M / F / D / P / GLBT / M / F / D / P / GLBT
Bangladeshi
Black African
Black Caribbean
Black Other
Chinese
Indian
Irish
Pakistani
Turkish
Turkish Cypriot
Vietnamese
White
Other
Totals
17. / Please give the following details of the members of your management committee:
Full name / Position Held / Home address / Telephone No.
Chairperson
Secretary
Treasurer
18. /
When was your committee last elected?
19. / Are any staff or committee members related to each other? If yes please detail.
20. / Bank Details
Name and address of
Bank or Building Society
Account Name / Account Number / Sort Code

How many people are needed to sign cheques for this account?
Please write their names and positions
Name: ______Position: ______
Name: ______Position: ______
Name: ______Position: ______
21. / Income: State income received in the last 2 years
Source / Amount
2010/2011 / Amount
2011/2012 / Office use only
Total

Details of your project

22. / Please tick under which theme the project you would like funded falls and describe the expected outputs and outcomes. Refer to guidance notes & Key Criteria
Building Social Capital (BSC)  Gateway Services (GS)
Children and Young People Programme (CYPP)  Communities that Care (CtC)
23. / Has the project / initiative been funded by the CSU or Lewisham before ? If yes please detail together with dates
24. / How many people will benefit directly?
What percentage of the users of the project live in Lewisham? / Existing users New users
…………%
25. / Please complete the equalities profile for your existing users
Users
M / F / D / P / GLBT / Key
Bangladeshi / M: Male
Black African / F: Female
Black Caribbean / D: Disabled
Black Other / P: Over 55s
Chinese / G/L/B/T: Gay/Lesbian/Bi-Sexual/Transgender
Indian
Irish
Pakistani
Turkish
Turkish Cypriot
Vietnamese
White
Other
Totals

What faiths, religions or beliefs are your users from? (please tick relevant box{es})

Buddhist / Christian / Hindu / Jewish / Muslim / Sikh / Other (please specify) / No faith
26. / What steps will you take to ensure that your project will be inclusive and accessible to all potential beneficiaries?
27. / How will the project make a difference to your users?
28. / How will you monitor the success of your project?
29. / If your application is to purchase equipment, where will it be stored?
30. / Will it be insured? / Yes / No
31. /
BUILDING WORKS APPLICATIONS ONLY
What work will be undertaken?
Address where work will carried out:
Who owns the building?
Is the building fully accessible and does it meet health and safety requirements? / Yes / No
Do you have written permission to undertake the work (including planning permission) /
Yes / No
32. / Expenditure: Please give details of proposed expenditure (all applications)
Item
/ Estimates
(£s) / Source of Costing / Office use only
Total
33. / Income: Please give details of any other income for this project
Source(s) of Income / Amount / Approved (please tick) / Awaiting Decision (tick) / Office use only
Total
34. / Total Grant Requested

Please now ensure that the Declaration is completed by the Chair of your Management Committee

Declaration
This application must be signed by the Chair of the Management Committee.
The information given in this application is correct. The organisation was neither
established for profit nor is conducted for profit . We will inform the relevant officer
at Lewisham Council of any changes in the organisation’s circumstances that would
affect this application or the use of any grant funding relating to it.
Name in block capitals: ______
Signed: ______Date: ______
On behalf of the management committee

CHECKLIST OF ENCLOSURES

Please enclose the following:

Names and addresses of the management committee (please give

details of any family connections among management committee

members and/or staff)

2011/2012 – if not yet ready - 2010/2011 accounts that have been independently examined or, if a new organisation, projected expenditure for 2012/2013

Copy of the organisation’s constitution or governing document

Copy of the organisation’s Equalities and Diversity Policyand Procedures.

Two quotes for works or equipment (if applicable).

Monitoring/Evaluation reports for previous funding (if applicable). If
you received funding for 2011/12 and the project has not yet been
completed, you will need to send in a progress report to date.

If your project is a Partnership Initiative, please send in all the above documents for your partner(s) as well as a formal terms of agreement that defines the partnership.

If relevant:

Volunteers’ policy

Child protection and vulnerable adults policy

Evidence for C.R.B checks and disclosures

Public liability insurance

REMEMBER ONLY COMPLETED APPLICATIONS WITH RELEVANT ENCLOUSURES CAN BE ASSESSED.

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