APPLICATION FORM:

This section includes basic information about your organisation.

Name of your organisation /group:
Contact details:
Name including title (Mr, Mrs, Miss, Dr):
Position in organisation /group
Address:
Phone:
Fax:
Mobile phone:
E-mail address:
Website:
Does the Community Group have the following? Pleasetick the appropriate box
Management Committee / Yes / No
Public liability insurance (If applicable) / Yes / No
Bank account with a minimum of 2 signatories* / Yes / No
Awareness of the safeguarding of children & vulnerable adults / Yes / No
Constitution / written set of rules
Please attach or email a copy with this application form / Yes / No

*Applicants must have a bank account in the group’s name

How much income did your group receive last year?

Usually, you must register with the Charity Commission if your charity is based in England or Wales and has over £5,000 income per year.

Here's the link to the Charity Commission website for more information:

If you have any queries, VAR may be able to assist you, please

Please tell us what your group does:

How much money do you need?

(The maximum amount a single group can apply for is £500)

How do you plan to spend the grant if your application is successful? Please tell us what you will use the money for:

Breakdown of costs

Item / Total cost
£ / Amount requested
£
Total amount required

When do you intend to carry out the project? The funding must be spent no later than 31st October 2018

‘Building Stronger Communities’ is one of the ‘game changers’ in the Rotherham Plan. For more information about the Rotherham Plan, click on the link below or copy into the address bar of your browser:

How will your project/activity have an impact, in terms of promoting and encouraging stronger communities?

Pleaseindicate which priority(ies) the activity will meet.

  • A strong civic community and pride of place

  • Bringing people from different communities together, e.g. different areas, backgrounds, ages, ethnic groups

  • Our rights and responsibilities towards each other

Please state here how the project/activity will impact on the priority(ies) selected

If your application is successful, how can you continue to support building of stronger communities after the funding has been spent?

How manypeople are likely to benefit from the activity or service?

Do you agree to provide both:

a) Appropriate evidence of approved expenditure, including receipts and invoices, showing how you spent the grant at the end of your project? Yes ☐

b) Appropriate details of impact and data re: the beneficiaries (no personal details expected without consent of the beneficiaries)? Yes ☐

You may be contacted for the availability of any promotional materials, where relevant, for e.g. photographs or to arrange and or take part in publicity relating to the funded project.

Please note:

If recording information containing personal information in any form you must ensure compliance with the Data Protection Act for all information systems (paper and electronic). Your organisation must also be registered with the Information Commissioners Office - The process is straightforward and only takes a few minutes. The annual cost of registration is currently £35.00.

Declaration

I confirm thatI am authorised to sign this application on behalf of the group, and the information given in the application is to the best of my knowledge true and correct.

Signature / Name in BLOCK CAPITALS
Position in group/organisation / Date

If you have any questions regarding this grant application form or for further information

please contact either:

Shafiq Hussain – email: Tel no. 01709 834458

Waheed Akhtar – email: Tel no. 07748 142669

If you would like to talk through your idea, please give Shafiq Hussain at Voluntary Action Rotherham a call.

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