Living Well in Woking Small Grants Scheme

Transcription

1 Living Well in Woking Small Grants Scheme Please read the guidance notes carefully before completing this form If you have any questions or require this form in a different format, please contact: Jade Buckingham, Living & Ageing Well Co-ordinator / jade.buckingham@woking.gov.uk 1: Your organisation Name of organisation Postal address (inc postcode): Telephone number: Name of contact: Job role of contact: address of contact: Organisation s website address: Contact address (if different from address of organisation) Purpose of organisation (please include your constitution, you may wish to send other supporting documents or continuation sheets) 1

2 Type of organisation (please tick whichever applies, and give registration number, if applicable) Voluntary or community organisation Constituted group Charity Partnership If your organisation if part of a larger concern, please give details below: 2: Your project Name of your project: When will the project/service commence? SECTION 3: Support for the Community Please give details of the project or activities for which the grant would be used, and explain how your application meets one or more of the key areas in the grant criteria please see Appendix A. 4: Extra facilities, equipment, services or activities that will be provided What new or additional groups, clubs or individuals would benefit if you were awarded this grant? 2

3 What new or additional facilities, equipment, services or activities would be provided if you were awarded this grant? 5: Local need and community benefit Where will your project take place, what evidence of need exists for your project, how many people will benefit from your project support? If your project will be run from a number of locations, please specify each. Does anything similar exist in the area? Will your project be open to all? Yes/No If the answer is no, please give details 6: Finances and viability of the project Budget for project in grant financial year Income Expected or Confirmed Fees/contribution from service users Grants/sponsorship (not including the grant for which you are now applying)* Sponsorship Other (please give details below) Total 3

4 Expenditure (running costs) Staffing Volunteer expenses Premises Insurance Office costs (equipment, telephones, postage etc.) Stationery, printing and publicity material Activity costs Hire of equipment Other (please give details below) Total Total cost Total income *Grants / sponsorship (not including the grant for which you are now applying) - Please identify who this was received from. Grant amount requested from Woking Borough Council limit Will project or service users pay a charge? Yes No If you do make a charge, could this be increased? If you do not charge, have you considered introducing one? Please explain below. Has this specific project previously received grant support from Woking Borough Council? If yes, please provide details. 4

5 How would this project be affected if: you did not receive a grant from Woking Borough Council you received a reduced grant from Woking Borough Council any of the income listed in Section 6 did not materialise How will the project be funded in future years (if applicable)? Where available, we require a copy of your most recent annual accounts. Where this is not possible (for example, where your organisation has been running for less than 12 months), please provide copies of your bank mandate and last three statements. Please tick the box that applies. I have enclosed copies of our most recent accounts I have enclosed copies of our bank mandate and latest three statements I am unable to provide the above information and have explained why below 7: Policies and Procedures Does your project involve work with children, young people under the age of 18 or vulnerable adults? If yes, we expect that the following will be in place. Please tick to indicate that you meet each requirement: Safeguarding policies appropriate to your organisation s work and the project you are asking us to fund Annual review process for your policies Suitable recruitment and selection processes for staff and volunteers who work with children, young people or vulnerable adults, including references and DBS checks Statutory guidance in relation to staff ratios followed Yes No 5

6 Risk assessments for all activities Appropriate levels of insurance for activities undertaken 8: Monitoring and Evaluation How will you evaluate your project as it progresses and on completion? Please tick those methods that you will use: User evaluation Stakeholder evaluation Usage/uptake of service External referrals Delivery of key objectives Planned financial income Other (please give details) 9: How did you hear about this grant? Signature of applicant Name Signature Position Date 6