Polden-Puckham Charitable Foundation Reg. Charity: 1003024 Oct 2014 version

Polden-Puckham Charitable Foundation

Application Form for Grant Funding

Before submitting an application please ensure that you are eligible for PPCF support by checking this on our web site. Please tick here when you have done so [ ]. The deadline for submission of an application to each grant round is indicated on our web site. Please complete this form in dark print (not grey, which is for our text), and number your paragraphs in the longer sections.

Data Sharing: PPCF uses an electronic database and internet ‘cloud’ service for storing and sharing applicant information between staff and trustees. We seek to keep this confidential within the Foundation, however by applying to us you are consenting to our using this system. Please contact us prior to submitting your application if you have any concerns.

Overview

1 / Name and Address of your organisation
Name of project (if different)
Website
Date organisation established / Date of Application
2 / Main Contact person
Position
Email/ Tel / E. T.
3 / PPCF area
Peace or Environmental Sustainability
4 / Is your request for Core or Project costs ?
5 / Aims and Objectives
The application aims and objectives (including what problem it will address) (300 words max).
How you plan to achieve these aims and objectives (including any unique benefits that your project offers) (300 words max).
How you will judge that the stated aims and objectives have been achieved (300 words max).
6 / Please explain how this matches Polden-Puckham’s stated aims (50 words max).
7 / Please explain how your work fits with others engaged in this field (100 words max).
8 / Please explain how the project is to be monitored, evaluated, and if relevant publicised (200 words max).

Money

Please answer in relation to your organisation, not your conduit.
9 / Total organisation income last year / £
10 / Have you had a previous application(s) to PPCF considered? If ‘yes’, was it/ were they successful?
Please give date(s), project name(s) and amount of grant(s).
11 / The budget of your project (organisation if you are applying for core costs) by year from this year (up to 3 years) / Year 1:
£ / Year 2:
£ / Year 3:
£
Amount requested from PPCF by year (up to 3 years) / Year 1:
£ / Year 2:
£ / Year 3:
£
Please include in your supplementary information a brief summary of your project/ organisational budget in the first year, so that we can see how our grant will be used in the context of the spending on this work.
12 / Main sources of income for last financial year (please give the three largest).
Source name: / Amount: £
A
B
C
Pending funding applications this year
A
B
C
D

People

13 / Give brief background details of 3 key people in the organisation. (50 words max)
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2
3
14 / Please describe your Board or Committee structure
How many members are there and how often does the Board/Committee meet?
Date of last meeting:
15 / In the organisation how many workers are there in total?
How many are paid and how many are volunteers (full time equivalents)?
Names, occupations and contact details (phone, email, address) of two referees.
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2

Final Details

16 / Is your Organisation a UK Registered Charity? If Yes, please provide the UK charity name and number.
Registered name: / Number:
If your organisation is not a registered charity, please provide the name and charity number of a UK registered charity, which will act as a conduit for funding for you. You must ensure that your conduit’s charitable objects cover the activities that you are asking us to fund.
Registered Name: / Number:
If your organisation has been investigated by the Charity Commission in the past five years please give details.
Please provide the conduit charity contact name, email address and phone number:
Name: / Email: / Phone:
17 / Grant Payments may be by BACS. Please fill in details of your bank, or yours conduit if you have one. NOTE - Grants will go astray and may be lost if account numbers are incorrect.
Bank Name
Account Number
Bank Sort Code
Does your organisation/project bank ethically?
18 / Does your organisation have an environmental/sustainability policy?
Please give brief details.
19 / Please supply any additional information of importance e.g. the imminent departure of a key member of staff.
20 / Checklist (please tick the circles to ensure this application is complete before submitting it).
o  Please ensure that all sections of the application form are completed.
o  An optional one page of supplementary information (maximum) can be added to the bottom of your application form (please do not attach a separate document).
o  Please send the document in Word, Pages, .pdf or LibreOffice format.
o  Please rename your document and your email with your organisation’s name and the year, e.g. ‘yourorganisationsname12.docx’. Please then attach this document to an email from your email address to
o  Please also attach as electronic copies your audited accounts and annual report from the last financial year attached to the same email (including a list of trustees/board members if not listed in your annual report). If you do not have electronic copies please send hard copies to Bryn Higgs, Secretary, Applications, BM PPCF, London, WC1N 3XX.
o  If you are a new organisation please indicate this, and send us what supplementary information you have.
o  Please do not send your application by post as it will not be accepted.
o  Note that you will receive an email acknowledgment. If you do not within two weeks of submitting it, or one week of the deadline passing (whichever is the sooner), please contact us without further delay to confirm that it has arrived. If you do not do this consideration of your application may be delayed.
21 / Typed name or signature of responsible person in the organisation, (also indicating that the application and checklist are correct and complete).

One side (maximum) of supplementary information may be added to this document below, but please at least include a brief summary of your project/ organisational budget in the first year, so that we can see how our grant will be used in the context of the spending on this work. Please ensure that all applications are on A4. Bryn Higgs (April 2013)

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