Westway CTInnovation Fund - Grant Application Form

Grant Round: 2015 - 16

Focus: New Activities or New Groups


BEFORE YOU START

It is important before completing the application form that you establish that this is the right grants programme for you. Answering the following questions will help you to determine whether your organisation and proposed activity match the requirements of this grants programme.

Eligibility question / Yes / No
Is your organisation a voluntary or community organisation with a written governing document (e.g. a constitution or a set of rules)?
Does your organisation have a governing body or management committee with at least 3 members?
If you selected ‘No’ for ANY of these questions, please contact us prior to submitting your application.
Are you seeking a grant of up to £5,000?
Will this grantbe used to offset driver and/or vehicle and/or fuel costs?
Are you an existing organisations who would like help with transport costs for a new activity or a new emerging group that would like to start activities that require transport?
Are you planning to use this grantin 2016?
If you selected ‘No’ for ANY of these questions, your proposed activity does not fit the requirements for this grants programme.
Have you already submitted other applications through the 2015-16 Westway CT Innovation Fund grant round?
If you selected ‘Yes’’ for this question, you need to withdraw your previous application if you wish to proceed with this one as only one application per organisation is allowed in this instance.

PROPOSAL OUTLINE

On no more than 4 sides of A4, please address each of the following areas in the order set out below.

  1. Describe your organisation, its purpose, service users, activities and achievements.
  1. Tell us about your proposed activityrequiring transport and for which you are applying for. Include details of:
  • start and end dates (funds must be used in 2016);
  • the geographical area(s)that your work will reach;
  • whether the activity is new or builds on existing work;
  • the purpose (or overall aim) of your project;
  • the specifics of when transport will be required, to what destinations and for how long, including details of the nature of the vehicle (expected number of passengers and whether they will need a wheelchair accessible vehicle);
  • any partner organisations that you’ll work with and what you’ll work on together;
  • if you are planning to only apply for vehicle costs, please tell us the training, support, and information you offer to your staff and/or volunteer drivers and/or passenger escorts who will deliver this work, including any relevant qualification and/or entitlements they hold.
  1. Tell us about your beneficiaries:
  • who will benefit from this activity?
  • approximately how many people do you expect to directly benefit? How did you arrive at this number? (this could be the number of people you are expecting to travel)
  • are there any specific communities do you expect to work with? If yes, be specific
  1. Help us to understand the context for your proposal. Tell us:
  • why this activity is needed (and how you know it’s needed)?
  • what difference the activity will make, and how you’ll measure this difference?
  • how this activity will complement and enhance any existing work?
  1. How will carrying out this activity help your organisation to meet its own goals:
  1. Explain why your organisation is well placed to carry out this activity (tell us about your knowledge, network, skills, experience).

SECTION 1: MAIN CONTACT

Please provide details of the main contact for this grant application. We will contact this person with any questions about your application, and inform them of our funding decision. It is important that they are contactable from 9am-5pm Monday to Friday.

Name / Title First name Last name
Role
Telephone
Email

SECTION 2: ABOUT YOUR ORGANISATION

Organisation name
Address / Postcode:
Telephone number
Email address
Website
Facebook username
Twitter username
Type of organisation, e.g. charity, community organisation
Charity AND/OR Company number
Is your organisation a local branch of a national/larger organisation? / Yes  No 
If you have answered yes, please specify:
Is this application being made on behalf of a coalition, or as a partnership? / Yes  No 
When was your organisation set up? / Month: Year:
What was your organisation’s income in each of these years (or since your organisation started if it is less than 3 years old)? / 2014/15 / 2013/14 / 2012/13
£ / £ / £
Do you have any of these policies/checks?
Please indicate ‘yes’, ‘no’ or ‘not relevant’ against each policy/check listed.
You do not need to attach copies of these policies at this moment but we may ask you for evidence at a later stage. / Policy/check / Yes/No/Not relevant
Safeguarding/child protection policy
Equal opportunities/diversity policy
Disclosure and barring checks
Health and safety policy
Public Liability Insurance
Employer’s Liability Insurance
Insurance cover for volunteers (e.g. Employer’s Liability Insurance)
Professional Indemnity Insurance
Contents insurance
How many people are involved in your organisation? / Role / Number
Volunteers and helpers
Full time paid staff
Part time paid staff

SECTION 3: BUDGET BREAKDOWN

Please provide a breakdown of ALL the transport costs for your proposed activity, based on the charge rate enclosed. Feel free to contact Westway CT, they will be happy to assist with quoting.

Item / Total cost / Amount requested
£ / £
£ / £
£ / £
£ / £
Total / £ / £

If this grant will not cover the total cost, how will you make up the rest of the money?

Source / Amount / Applied (Yes/No) / Decision
£
£
£
Total / £

SECTION 4: DECLARATION

This form must be signed by a member of your organisation’s governing body.

Information in this form and in the supporting documents will be used for grant assessment, monitoring and evaluation purposes and will be stored electronically.

Information may be shared with other individuals and agencies to assist us with assessing applications, preventing and detecting fraud, complying with the requirements of our auditors, monitoring grants, and evaluating their impact.

Please tick this box  to declare that:

  • you have read and agreed to the above statement;
  • if successful, your organisation agrees to submit any evidence if requested;
  • you have and understood the purpose of this grant and its conditions;
  • the information provided in this application is correct to the best of your knowledge;
  • the supporting documents are current, accurate and have been approved by your organisation;
  • where relevant,this application has been agreed and ratified by your organisation’s governing body;
  • if applying as part of a partnership, the lead organisation accepts responsibility for managing the grant, and will take full responsibility for all aspects of it.

Signed, for and on behalf of

……………………………………………………………………………………………………

(organisation name)

Name

………………………………………………………………………………….

Position held in organisation

…………………………………………………………………………………

Signature Date

SECTION 5: COMPLETING YOUR FORM

Please submit ALL the relevant documents with your application:

Attachments: / Attached?
Yes, No, Not applicable
If you are NOT a registered charity, include a copy of you organisation’s governing document (e.g. your constitution or governing document).
If NOT available on the Charity Commission website and/or you are NOT a newly formed organisation, a copy of your annual accounts OR an income and expenditure summary for 2015/16 (signed and dated by your Chair, Secretary or Treasurer).
A copy of your organisation’s 2014/15 annual report or review (indicate if you have not produced an annual report or review).
An original signed letter of reference from an independent referee.
Please attach the name and contact details of a member of your Management Committee, who we can contact for clarifications regarding this application. Please ensure they are aware of this application.
For local branches of national/larger organisations: An original letter from your ‘parent’ organisation in support of your application, and accepting overall responsibility for its content and the management of any grant awarded; signed by a senior member of staff.
For partnerships: A separate signed partnership statement for each key partner.

SECTION 6: HELP US TO IMPROVE

We want to learn about your experience of applying for funds from us. By answering the questions below, you can help us to improve our grant making.

Issue / Rating
Very easy / Quite easy / Quite difficult / Very difficult
How easy was it to understand the eligibility criteria for this grant?
How easy was it to complete the application form?
About how long did it take you to complete the application form?
How did you hear about this grants programme?
Please tell us your comments and suggestions about our work and your experiences of Westway CT.

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