To Support Disadvantaged Older People in the Bailiwick to Be Independent, Healthy And

Pargiter Trust GrantsApplication Form:Round 3, March 2016

To support disadvantaged older people in the Bailiwick to be independent, healthy and socially included.

Opening date for applications: Thursday 10th March 2016

Closing date: Thursday 7th April 2016

PLEASE READ THE GUIDELINES ACCOMPANYING THIS FORM BEFORE COMPLETING IT.

GRANTS CRITERIA FOR APPLICATIONS

Improving health & well-being – Reducing isolation, providing hot meals and refreshments and helping older people to stay active through sports, arts, recreation, social clubs and volunteering;

Improving access to facilities, advice and training – Providingtransport, supporting Good Neighbourhood and befriending schemes and improving access to information and IT for older people;

Overcoming problems - Helping older people who are experiencing difficult circumstances due to an illness, injury, disability, bereavement or financial difficulty

The Pargiter Trust defines older people as being over 65 years of age and applications should focus on this age group.

Application forms may be completed by hand or electronically.If you need any assistance to complete the application form please call Sadie on 748056 or email

ABOUT YOUR ORGANISATION

Q1 Contact Details

Name of the organisation

Address of the organisation

Post Code:

Website (if applicable)

Main contact for the application (this should be a person closely involved who can discuss the application)

Name

Position held in the organisation

Contact address (if different from above address)

Post Code:

Daytime phone numberE-mail address

Q2If your organisation is registered as a Charity or Non-Profit Organisation with the States of Guernsey Income Tax Authority, what is the registration number?
Q3 What does your organisation do and who does it help/work with?
Q4 What is the need for the work of your organisation?
Q5 How many people are involved in running your organisation?
Management/Committee members / Full-time paid staff
Part-time paid staff / Volunteers

ABOUT THE PROJECT/ACTIVITY/SERVICE

Q6 Please describe the project/activity/service you would like to be funded and its intended outcome

(what you would like to achieve?):

Q7 How will this project/activity/service meet either one or more of the following criteria?:

Improving health & well-being – Reducing isolation, providing hot meals and refreshments and helping older people to stay active through sports, arts, recreation, social clubs and volunteering;
Improving access to facilities, advice and training – Providingtransport, supporting Good Neighbourhood and befriending schemes and improving access to information and IT for older people;
Overcoming problems - Helping older people who are experiencing difficult circumstances due to an illness, injury, disability, bereavement or financial difficulty;

Q8 How many older people (age 65 plus)will benefit from the activity?

Q9 What will the impact of the proposed activity be on your beneficiaries, clients or service users?

Q10How will the activity, project or service provide a lasting benefit to the community or beneficiaries?

Q11Are you the right organisation to be carrying out this work? Please explain why

Q12 Is this application for new work, or to continue funding existing work?

New work / Existing

FINANCIAL DETAILS

Q13 How much are you applying for? / £
Please provide a brief breakdown of your funding request showing e.g. equipment/training/staff costs: / £
£
£
£

Q14 What are the usual sources of income for your organisation? Please specify if these are from the public, States, the Association of Guernsey Charities Lottery Grant, business sector or a combination of sources.

Q15Please provide the total of all monies held by your organisation (all accounts and investments) as at the end of February 2016.

Q16Is there a reason why these reserves cannot be used for the project/activity/service you are applying for?

Q17How much income does your organisation need to run on a yearly basis?

Q18Have you applied for funding from any other source for this same project/activity/service?

If so, please specify:

Q19What are your general funding needs for 2016? When it cannot provide funds itself, the Foundation tries to source other funding for voluntary organisations, so knowing current needs will assist us with this search.

DECLARATION

I am authorised to make the application on behalf of the above organisation.

I confirm that the information contained in this application is correct and that if a grant is awarded it will be used only for the purpose stated and according to the terms and conditions of the grant.

The details of this application will be entered onto the Guernsey Community Foundation’s database in order to process the application.

If the application receives funding, the Guernsey Community Foundation will release details of the amount given, and how it will be spent, to the media and will use this information for promotional purposes.

If the application is not successful, the Foundation may on occasion, in confidence, pass details of your application on to a potential donor for their consideration. If you would likeyour application to be forwarded in these circumstances, please tick here:

The Foundation may occasionally send you electronic updates regarding its work. If you would like to receive these updates, please tick here:

Signed: / Date:

REMEMBER TO KEEP A COPY OF THIS FORM FOR YOUR RECORDS

Please send your completed form and any enclosures to:

Sadie Siviter de Paucar, Guernsey Community Foundation,

1st Floor, Tudor House, Le Bordage, St Peter Port, GY1 1DB

or via email to