East Suffolk Youth Priority Action Group

Working in partnership for young people across East Suffolk

Youth Holiday Activities Fund for East Suffolk

Grant Application Form

Please read the accompanyingguidance notes carefully before completing this application, and answer all questions as fully as possible.

Once completed, please return this form with all relevant supporting documents to:

or

Stuart Halsey, Active Communities Officer Suffolk Coastal and Waveney District Councils, Riverside, 4 Canning Road, Lowestoft, NR33 0EQ

Key Information

This funding round is for activities to be delivered in May/June Half Term andSchool Summer Holidays 2018.

Deadline:Friday 16th March 2018, 17.00 – Applications received after this deadline will not be considered.

Please note that for this funding round, all applicants will be requested to deliver a short proposal presentation to the Commissioning Panel on Wednesday 4th April 2018,irrespective of application value. This will take place at the following venue:

Suffolk Coastal District Council

East Suffolk House, Station Road, Melton, WoodbridgeIP12 1RT

For more information, please refer to guidance notes.

Application Summary- Please state name of proposed activity and total amount applied for.

Activity title
Organisation name
Total value applied for / £
School holidays covered by this activity / Please check boxes as appropriate.
Summer Holiday ☐
October Half-term ☐
Christmas Break ☐
February Half-term☐
Easter Break ☐
May Half-term ☐

Section A - About Your Organisation

A1. Contact Details
Contact Name: / Organisation Name:
Position:
Address: / Email Address:
Telephone Number:
A2. What is the Legal Status of Your Organisation?
Please check the relevant box.
Unregistered voluntary or community group ☐
Registered charity ☐
Local branch of a national organisation ☐
Charitable company limited by guarantee ☐
Community/social enterprise ☐
School or statutory body ☐
Town or Parish Council ☐
Other – please state below☐
If you are a registered charity, please state your number:
A3. Organisation Description
In no more than 75 words, please tell us about your organisation and its aims.
A4. Does your organisation have the following policies and documents?
Please check the appropriate box. Copies of these documents must be submitted.
Constitution/Set of rules ☐
Equal Opportunities Policy ☐
Child Protection Policy ☐
Health and Safety Policy ☐
Safeguarding Policy ☐
DBS Certificates of Main Project Leaders ☐
Public Liability Insurance ☐
Amount of cover provided by public liability insurance:£
A5. How many people are involved in your organisation? The volunteer total should include volunteers who are members of your management committee or assist in delivering services.
Management Committee/Trustees
Paid staff
Volunteers/Clients/Members

Section B – Your Project/Activity

B1. Project/activity description / Summarise here what the activity is about.
B2.
Aims, outcomes and benefits / B2a. What are the aims and expected outcomes of this project/activity? How will young people benefit from taking part?
B2b. What are the wider community benefits of this project/activity?What positive impact will this activity have on the local area?
B3.
Indicative delivery plan
Information provided can be indicative. The Commissioning Panel is aware that plans stated here may change during delivery. / B3a. Please indicate in the table how many sessions per week this activity will run, and on which day of the week? Check boxes as appropriate.
Week / Mon / Tues / Wed / Thurs. / Fri / Sat / Sun
Summer 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 3 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 4 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 5 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 6 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Oct HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Christmas 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Christmas 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Feb HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Easter 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Easter 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
May HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
B3b. What is the average session duration ? E.g. 2 hours per session.
B4.
Target audience / B4a. How many young people do you anticipate this activity will engage with? Give as much detail as possible: e.g. 50 individuals in total, up to 20 per session.
B4b. What age range of young people is this activity/project aimed at?
B4c. Will your proposed activity/project be open to:
Please check as appropriate
  • Existing service users only ☐
  • All young people, including those who have not previously engaged with your organisation☐

B5.
Project/activity development / B5a. How have you identified the need for this project or activity? Where did the idea come from? Do you have any quantitative or qualitative evidence?
B5b. How are young people involved in the development of this project and this application process?How did you engage and consult with young people in the planning of this project/activity?
B6.
Evaluation and publicity / B6a. How will you monitor and evaluate your project/activity?
How will you find out if the outcomes and aims stated in question B2 has been achieved? How will you identify what went well/less well? E.g. through surveys of participating young people etc.
B6b. How will you publicise your activity to young people in the local area?

Section C – Finance

C1. Please provide us with a breakdown of the total cost of this project. Please give as much detail as you can to support your costings. Please provide any quotes if applicable.
Note: If this application is for funding to support parts/aspects of a larger project, please give the total project cost breakdowns in the Total Item Costs column, and specify how much funding for each element you are seeking from the panel in the Amount Applied For column.
Item/Activity / Total Item Cost (£) / Amount Applied For (£)
Total Cost / £ / £
C2. Is there any match funding towards this project? Please refer to guidance notes for examples of match funding.
Source of Match Funding and Details / Amount (£) / Secured?
☐
☐
☐
☐
Total: / £
C3. Do you have any additional details or supporting comments regarding your project costs or match funding which you would like to make the panel aware of? This is an optional question.
C3. Will there be a charge to the young people wishing to participate in this activity? If so, how much are you planning to charge per session? Please note the answer to this question will only form a small part of the panel’s overall assessment of value for money.
Yes ☐ £
No ☐

Section D - Declaration

This declaration should be signed by the chair person, secretary or treasurer.

I am authorised and eligible to sign this application on behalf of the organisation and declare the information included in this application is true and accurate. I understand that the information provided will be used to assess this application and subsequently to monitor the activities that the organisation has set out. I understand that in the assessment of this application the Commissioning Panel may share information contained with it with relevant partner organisations.

Full name:
Signature:
Position:
Date:
Data Protection
Some information provided on this application form will be held on a database and will be covered by the Data Protection Act 1998.

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