Pitch pot Application Form

Please fill in this form when making a Welsh film pitch pot application. Make sure to read Film Hub Wales’ Welsh Film Guidelines beforehand for each section. We have given a suggested word count for each question. Please give succinct answers but describe your project in enough detail.

Section 1: Application Details

Grant applied for:(please tick) / ☐Heritage(includes Welsh film)
Date of application: / Project title:
Name of applicant: / Organisation Name:
Email: / Phone:
Project start / end date: / Project language: / ☐ English ☐ Welsh ☐ Bilingual
Projected total audience: / Projected number of Independent (British or world) films:
Number of projected screenings/events: / Proposed venues(s):
Amount of funding you are applying for: / £ / (Note that Film Hub Wales can only offer up to 50% of the total budget. 50% should be supplied in cash or in-kind match funding, such as box office)

Section 2: Diversity

Your project area/background:(please tick all that apply) / ☐Rural
☐Old age groups
☐ Urban / ☐Low socio-economic groups
☐BAME
☐Minority languages / ☐LGBTQIA+
☐Young audiences
or families
☐Other (please specify):
Your area’s LSOA ranking on the 2014 Welsh Index of Multiple Deprivation:
(from 1 being most deprived to 1909 being least deprived):

Please give any additional information here on how your project meets the BFI Diversity Standards:

On screen:
(diverse narratives, cast and places depicted) / A diverse crew:
(explore who makes the films we screen)
Industry access or training:
(ensuring that we offer accessible opportunities through our projects and organisations) / Catering for audiences:
(provision of disability access, specialist projects for target audiences, providing for specific UK regions etc).

Section 3: About your event

Please tell us which films you plan to programme by completing the box below (this may be draft at this stage –
see examples below and give as much detail as relevant):

Film name(s) / No. of proposed screenings / Screening/event detail
/ What kind of films are you screening? / Added value / How did you find out about this film?
e.g. Q&A, discussion, workshop. / e.g. Archive, Foreign language, audio described, silent films. / e.g. programme notes, vox pops, photography. / e.g. Screening/Preview Day, FHW newsletter, FHW Preview Room.
  1. Please provide a short description of your project:
    (i.e. how would you want your project to be summed up in two sentences? What events, workshops, master-classes, networking etc are you planning?)

What are your aims and objectives?
i.e. What do you want to achieve by the end of this project? Think about the Film Hub Wales guidelines and remember what we can’t support (guideline 150-200 words):

Section 4: Other information

Please list the partners you are working with on your project:

Partner name / Region (e.g. Wales, UK, International) / New/Existing / Nature of partnership
How will you evaluate your project? Film Hub Wales will supply a report and survey template but do you have any interesting ways of engaging your audiences in feedback and research? (100-200 words):
How will you market this project to audiences? Think outside of the box from working with specialist partners to targeting local groups (If you have a separate marketing/audience development plan, please attach) (100-200 words):

Budget

Please complete the project budget (downloadable from our website here) completing all sections.
Seeour handy budget tips sheetfor help.
*Note that Film Hub Wales can only contribute up to 50% or a maximum of £10,000 per project, with a ceiling of £15,000
per provider per annum.

Please give details of any other applications for support you may have submitted to other Film Hubs across the UK (if relevant):

Application Checklist: (please tick)

☐ Completed application form (including budget – download template here)
☐ Marketing / audience development plans (if separate)

☐ CV’s and background information on organisation (first application only)

☐ Welsh language policy (link to website is acceptable – first application only)

☐ Management accounts executive summary showing organisational profit or deficit(once annually)

☐ Evidence of protection policies and recruitment, selection processes and for individuals working with children
and vulnerable adults, project staffing plan including numbers of children per supervisor (if applicable)

Signatures and Declarations

Please Note

The information you supply may be held on computer. It may be used to process applications, awards and to prepare statistics. We may also be obligated to share information under the freedom of information act. Film Hub Wales reserves the right to cancel any application and require repayment of funds if false or incomplete information is supplied.

Please sign to confirm the following (Note: the signatory must be the individual named previously as project applicant):

I confirm that all information provided on this application, and in any material submitted in support of it, is truthful and accurate. I agree to share this information with Film Hub Wales and its funders. I confirm that all other applications to other distributors of Lottery awards have been declared. I undertake to inform Film Hub Wales fully and immediately of any changes affecting this application or related materials.

I confirm I have the authority to make this application on behalf of the applicant organisation.

Name: / Position:
Signature: / Date:

Co-signature (if required under company regulations):

Name: / Position:
Signature: / Date:

Contact details

If you have any queries, or if you would like to discuss any aspect of your project prior to application, please contact (and submit your final application to):

Lisa Nesbitt, Development Officer | | 02920 311067
Chapter, Market Road, Cardiff, CF5 1QE |