Belfast Cathedral Sit-out

Application Form 2017

Please complete all five sections using BLOCK CAPITALS

Please refer to important Terms & Conditions at end of the application form.

Section 1 – Contact details

Name of charity / organisation:______

Key contact person: ______

Address:______

______Postcode:______

Telephone No.: ______

Email: ______

Website : ______

Approximate date charity / organisation was established: ______

Section 2 – Charity Financial Details

Number of paid staff: ______Number of volunteers: ______

Number of individuals benefiting: ______

Gross Income 2016 (NI): £ ______

Gross Expenditure 2016 (NI): £ ______

Gross Income 2016 (Outside NI): £ ______

Gross Expenditure 2016 (Outside NI): £ ______

Charity No. / Income Tax No. (NI): ______

Please include a set of audited accounts for the last complete year

Section 3 – Grant Category

Please indicate which category you wish to apply under(tick box):

A – Child related groups / projects (under 16)

B – Youth related groups / projects (16 – 25 years)

C – Community serving groups / projects

D – Family related programmes

E – Medical research / Support

Section 4 – Charity / Organisation Descriptions

In the space below, please give a summary of the work your organisation undertakes and indicate the specific use(s) to which any grant from the Sitout would be put. (Please ensure information is legible and contained within the box)

Section 5 – Application Correspondence

Please indicate your preferred method of correspondence. (tick box):

Email – (please ensure that an accurate email addresshas been given in Section 1)

Post – (please include a small SAE with your application form)

Terms and Conditions

  • Due to the large number of applications expected, we will strictly NOT process any late applications.
  • Due to existing commitments we are unable to donate to any more projects abroad.

Grants are made subject to the following conditions:-

  • The grant awarded is separately identified as received from “St Anne’s Cathedral Sit-Out” within the annual accounts or Annual Report of the organisation.
  • The grant award is given appropriate publicity and acknowledgement in the organisation’s relevant documentation.
  • All successful grant awards will be distributed at The Good Samaritans’ Service held in St Anne’s Cathedral on Sunday 4th February 2018. Please ensure that a representative is able to attend this service if your application is successful.
  • You present your cheque award to your bank without delay. Please note that lost or mislaid cheques will NOT be re-issued.
  • Please be aware that in the case of successful applicants, information given in Section 4 may be used by St Anne’s Cathedral to publicise future Black Santa Sit-outs and / or Good Samaritans’ services.

Declaration

I confirm that I have read and understood the above terms and conditions:-

______

SignedDate

______

Pirnt Name:Position in Organsiation

NOTE: Completed forms should be submitted by Friday 27thOctober 2017 at the latest and posted to:Belfast Cathedral, Sitout Applications, c/o Administrator, Donegall Street, Belfast, BT1 2HB.

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