Healthy Sandwell Micro-Grant Fund

Application Form

Please refer to Healthy Sandwell Micro-Grant Fund guidance notes for information and advice on how to complete this form. If you require any further assistance with making your application, please contact SCVO on 0121 525 1127 or email Stuart Ashmore at

Information about application deadlines is included within the guidance notes.

Eligibility

Please tick to confirm the following:

Your organisation is a not-for-profit organisation that fits within Sandwell Council’s definition of the Third Sector

Your organisation is currently active, delivering support and services to residents in the borough of Sandwell

Your Group / Organisation

Name of Group / Organisation
Full address of Group /
Organisation, including
postcode
Main Contact Person / Title: Miss/Ms/Mrs/Mr/Other
Name:
Role / Position:
Telephone:
Mobile ‘phone:
Email:
Web address / Facebook page
(if appropriate)
Q1. Describe your proposed Engagement Activity…what do you want to do, where and when will your activity take place and how will it include a required ‘health-related promotion’ / which service(s) will you be promoting? (Max 250 words)
Q2. How many people, between the ages of 25 and 74, will be engaged in your proposed activity? (we anticipate engagement of a minimum 25 people per activity)
Q3. How will you promote your Engagement Activity in order to ensure its success? What methods will you use? E.g. social media, printed flyers, word of mouth etc. (Max 100 words)
Q4. How confident are you of attracting the number of people in Q2 above and that this activity will be relevant / appropriate? What have you done in the past that has worked and that makes you confident of attracting the projected numbers / client group?(Max 100 words)
Q5. What other contribution / resources might you offer as part of your proposed activity? E.g. volunteer time, venue, equipment etc. (Max 100 words)
Q6. How much money are you applying for? (Up to £250)

Declaration

We agree to abide by the terms and conditions of the grant and understand that any offer of a grant will be subject to proposed work remaining within the grant criteria. We agree to participate in monitoring, auditing and evaluation related to this fund.

If the application is successful, details of the award may be published on SCVO’s website and other media. Confidential or commercially sensitive information will not be made available publicly.

Signatures confirm your acceptance of these conditions.

Organisation Chief Officer / Senior Manager / Lead Officer

Signature
Please sign
Name
Please print or type

Organisation Chair or Secretary

Signature
Please sign
Name
Please print or type

SCVO is registered to hold data under the Data Protection Act 1998

What next?

Please ensure that you have read the accompanying guidance notes and completed all sections of the application form.

Send your completed application to:

SCVO

1st Floor, Landchard House

Victoria Street

West Bromwich

B70 8ER

Or by email to:

1