Please complete and submit this Application Form in accordance with the accompanying Guidance Note and Prospectus (available on the Skills Capital page of the Local Enterprise Partnership website:
Applicants are reminded there is an overall minimum total project value of £50,000 (excluding VAT) and minimum individual item value of £1,000.
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Skills Capital Investment FundSection 1: Applicant Contact Information
Name of Lead Applicant Organisation: / Insert the legal name of the organisation applying for the equipment grant that is responsible for the application and all assets that this project will attract.
Lead Applicant Address:
Contact Name and Job Title:
Contact Telephone:
Contact Email:
Partner Organisations: / For projects submitted by a lead organisation on behalf of a number of associated partner organisations
Section 2: Project Details
Title of Project: / Insert the title you have given the project. This will be used for reference purposes, so should be kept short.
maximum of 10 words
Project Summary: / Provide a brief summary ofthe proposed equipment project, including: project overview, summary of aims and objectives, anticipated target beneficiaries/groups and what quantifiable and tangible outcomes are likely to be achieved.
maximum 100 words
Total Project Cost: / £[ ]
Grant Requested: / £[ ] Percentage [ ] of total project costs
Location of Project
(inc post code): / Provide the address the proposed project will be located including postcode.
Has the project previously been considered by the Skills Funding Agency or other funding bodies? / Delete as applicable:
Yes/No
If Yes, state the outcome and any subsequent changes made to the project.
maximum 100 words
Project priority, with 1 being the highest (NB only applicable if submitting more than one project under Strand 3):
Section 3 :Specialist Equipment to be purchased and grant requested
Use of equipment / Provide a short, simple and non-technical description explaining the specialist nature of the equipment required.
In addition to the information provided here, please submit a shortEquipment Use and Maintenance Planwith your application, setting out the information asked for in the guidance note.
maximum 400 words
Complete Table 1 below to show the detail of the equipment and the costs.
Table 1: Detail of Equipment and Costs
Description – including name and model of the equipment: / Quantity (a) / Item Cost, including VAT if applicable (b)
£ / Total Cost including VAT if applicable (c)
(c = a x b)
£
d - Total Purchase Price of all equipment (sum of c) / £
e- Total Grant support @ 50% (e = d x 50%) / £
f – Total value of specialist equipment donations / £
Reminder:The City Regionwill require successful applicants to provide proof of all purchased equipment costs. Where equipment includes an element donated by third parties as part of the applicant’s match funding, we also require evidence of the value attributed to this equipment. The City Region is unable to pay capital grant for items where there is no appropriate proof of the cost.
Section 4:– Project Business Case
Skills for Growth Delivery: / Explain how the project meets the criteria and evidence requirements set out in the Section 3 of the Strand 3 Guidance Note (3.2.2).
In particular, applicants should provide evidence of how their project fits within the economic context of the Liverpool City Region and meets the skills for growth and skills capital investment priorities set out in the Skills Capital Investment Fund Prospectus.
Applicants are reminded not to exceed the maximum word limit of 250 words and to support their case using robust quantifiable and achievable measures.
Maximum 250 words
Need for investment: / Explain the key drivers for the project and how the project will be fit for the purpose intended including the reasons required and the benefits achieved
maximum 250 words
Educational / Learner Benefits: / Complete Table 2 and 3 below to show the number of learners that will benefit from the project.
Table 2: Principal Learner benefits from the project
Learner Level / Learner numbers before project
[1] / Learner numbers after project
[2] / Change in learner numbers
= [2-1]
Adult Skills Classroom-Based
16-18 Apprenticeships
Adult (19+) Apprenticeships
Adult Skills Workplace
Traineeships
Total
Table 3: Ancillary learner benefits from the project
Learner Category / Learner numbers before project (1) / Learner numbers after project (2) / Change in learner numbers (2-1)
14 – 16
16 – 19 EFA
For any growth in learner numbers listed above, please state will the growth by realised by re-aligning current allocations/budgets or will it be a result of future growth applications?
maximum 100 words
Providing benefits to learners: / Explain how the project will provide benefits to learners, including:
- Which curriculum areas will be affected by the project?
- A positive and measurable impact on adult (19+) learners, Apprenticeships and Traineeships
- A flexible resource base and industry-standard environments for vocational learning
- Quality of teaching and learning
- Learner achievement rates
- Wage progression/uplift and employment outcomes
Section 5: Project Funding and Finance
Project Funding/ Finance: / For all projects:
Complete Table 4below to show how the project is to be funded/ financed.
Table 4: Funding/Financing of Proposed Project
Project funding/financing / Capital cost (£000)
Private sector / £ [ ]
City Region Skills Capital Investment Fund / £ [ ]
Applicant’s contribution (cash reserves) / £ [ ]
Loan finance / £ [ ]
Disposal proceeds / £ [ ]
Other public sector grants / £ [ ]
Other / £ [ ]
Total / £ [ ]
Confirm if you have secured/guaranteed all non-City Region funding (YES/NO) and complete Table 5 identifying funding sources:
Table 5: Funding Sources of Proposed Project
Source of Non-City Region Funding / Amount of Funding (£) / Confirm if funding secured/guaranteed (Yes/No)
Total
Additional comments (for example any conditions associated with the provision of third-party funding/financial contributions):
maximum 300 words
Affordability: / For projects requesting over 50% grant funding:
Applicants will need to demonstrate that they will be financially viable after taking account of their contribution to the project, including any associated borrowings.
Applicants are required to submit a financial plan (Excel format) as part of the application. The financial plan should be for at least two years after project completion.
Expenditure Profile: / For All projects :
Complete the planned expenditure profile template for the period 11 May 2015 to the planned completion date of the project. This may include planned expenditure beyond 31 March 2017 where this is funded by match funding only. NB The total cost in the planned expenditure profile should equal the total project funding in table 1 above.
Confirm the amount of LEP skills capital investment funding to be claimed by :
31 March 2016 [£ ]
31 March 2017 [£ ]
Section 6: Measurable Objectives
Measurable Project Outputs: / Provide a minimum of three specific, measurable, achievable, realistic and time-framed (SMART) objectives/outputs arising from the acquisition of the proposed equipment.
maximum 250 words
Section 7: State Aid Risk Assessment
Statement: / By signing the declaration below, I confirm that to the best of my knowledge the project complies with the EU State Aid rules and confirm, if made a grant offer, I will supply satisfactory legal evidence to support this.
NOTE: If your organisation is successful in receiving a grant award it will be a condition of funding that you repay any funds in the event that the Commission determines that they constitute State Aid, which is incompatible with the common market.
Section 8: Declaration
Declaration: / I certify that the information provided in this application is complete and correct.
This project has not been the subject of a successful capital funding application to the Skills Funding Agency or received any other public capital funds.
Signature
(Chief Executive / Principal):
Print Name:
Date:
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Skills Capital Investment Fund