Carers Social Action Support Fund
Application Form
Please read the guidance notes before completing this application form.
If you have any queries about the application form or how to apply, or if you have any particular communication needs (such as Braille, large print or a hearing impairment) please contact us on 0207 842 7788 or email . The document is available on request in alternative formats to suit different communication needs.
The £1 million fund will support programmes which use social action to support carers. Funding will be provided until October 2015 but the majority of funding must be spent by 30th June 2014. The minimum grant size will be £50,000.
Please fill in this application form and send to no later than: noon on Wednesday 22nd October. Please also attach any supporting documentation. Where specified, do not exceed the word limit.
Please ensure you read the specific guidance for each question and complete each of the sections prior to submission. Incomplete applications will not be considered.
Eligibility Checklist
Please indicate whether your proposal meets our eligibility criteria.
Eligibility criteria / Yes / NoThe benefits of my proposal focus on England
My proposal will benefit adult carers caring for another adult only
The proposal will reach at least 50 carers (all of whom are new to the service)
Volunteers are core to the delivery of the service I am proposing
I can confirm that this proposal complies with State Aid guidelines
The benefits of my proposal focus on England
The money I am applying for will be used primarily to fund revenue costs, with no expenditure on capital items with a value in excess of £5,000
The organisation(s) submitting this proposal are in a position to accept a grant offer by November 2014 and spend this by the end of October 2015
Your Organisation
Main Contact Details
Name
Position /
Primary Telephone /
Secondary Telephone /
Email /
Organisation Details
Organisation Legal Name(s) /Address /
Organisation Telephone
Organisation Email
Website
Please note we will use this as the main post address for all correspondence regarding this application
What is your organisation’s legal status?
Legal status / Yes / NoA legally constituted Civil Society Organisation (this could be a company limited by guarantee, or CIC for example) which may, or may not, also be a registered charity
A public sector body, for example local authority, hospital trust, school or university
A business with a social mission or clear objectives in its corporate social responsibility policy toward increasing social action, or business involved in the delivery of public services
If you are a registered charity, what is your charity number?
What are the aims of your organisation as expressed in your governing documents? (maximum 200 words)
Your Application
Summarise your social action programme (50 words)
How many carers (who have not used the service before) will your proposal reach?
Are you applying in partnership? If so, please provide the names of all of the partner organisations.
How much funding are you applying for?
Please note: you will be asked for a breakdown of project costs in the Proposal Details section of this form. Please ensure that you cross reference the total amount requested here with the figures elsewhere in this form
£
Where will your proposed social action programme operate?
Section 1 - Your Proposal
1. Please describe the existing service or initiative that you plan to grow or adapt through this proposal (maximum 400 words)
2. Please describe the project you would like us to fund , and how our money will help you do that (maximum 600 words)
3. Who is the target group for the service? Why have you decided to focus on this group? (maximum 500 words)
4. What is the likely impact of this service on the outcomes we are interested in? What is the evidence for this? (maximum 500 words)
Section 2 - Measurement of Impact
5. Please tell us what data you collect, and how, from a relevant service(s) that you currently run and which you plan to grow or adapt with this funding. How does this enable you to demonstrate impact? (maximum 300 words)
6. How would you envisage working with the external evaluator we plan to recruit? (maximum 500 words)
Section 3 – Sustainability
7. Please describe how your proposal fits into the broader plans and priorities of the key players in your local health and care system (maximum 300 words)
8. Please briefly outline the current funding model for any existing relevant services you deliver which you would be growing or adapting with this proposal? (maximum 300 words)
9. If we choose to fund your proposal, our funding will stop in October 2015. How will you fund the service after that point? (maximum 300 words)
10. Please list any match funding from external sources you have secured against any grant from this fund (maximum 300 words)
11. Please list any other recent funding proposals you have made to other government departments or other external funders for this kind of work in the locality in question
Please list funding proposals in the last two years, how much you have applied for, what your bid was for and whether or not you have been successful
Funder / What was the funding for? / Amount requested (£) / Secured?Section 4 - Capacity to Deliver
12. Who will be directly responsible for the day-today running of the project, and what is their experience? (maximum 400 words)
13. We plan to confirm grants to successful applicants in early November 2014. We want the projects we fund to be fully operational by February 2015 so between November and February projects will need to setup/scale up at speed. Please set out your mobilisation plan detailing how you will set up/scale your project between having your grant confirmed and February 2015 (maximum 500 words)
14. How will you know, during the delivery of your project, whether or not it is having the impact you intend? And how would you act to improve performance if necessary? (maximum 500 words)
15. Please specify the milestones and key deliverables for your proposal in the table below
Please note that the milestones entered here will form part of your monitoring if you are successful.
Milestone / Nov 2014 – Feb 2015 / March 2015 - June 2015 / July 2015 – October 2015Number of carers supported
Number of Volunteers recruited
Staff recruited
[insert milestone]
[insert milestone]
[insert milestone]
[insert milestone]
[insert milestone]
16. Please provide a budget breakdown for your project.
Expenditure (£) / Total (£)[Add direct project costs e.g. seminars, travel etc]
[Add direct project costs e.g. seminars, travel etc]
[Add direct project costs e.g. seminars, travel etc]
[Add indirect project costs e.g. proportionate towards overheads including staff time]
[Add indirect project costs e.g. proportionate towards overheads including staff time]
[Add indirect project costs e.g. proportionate towards overheads including staff time]
Total expenditure
Amounts covered by other funding
Total requested
17. Please complete the table below to show your organisations recent financial track record for the last financial year for which you have audited accounts and management figures for the current year to date
Annual accounts 2012 – 2013 / Annual accounts 2013 - 2014 / Management figures YTD / Projected full year figuresTotal Income
Total expenditure
Surplus/deficit
Current assets
Current liabilities
Fixed assets
Term liabilities
Unrestricted funds
Restricted funds
Total funds
State Aid
18. Will the social action project you propose result in creating any goods or services which could affect trade between EU member states?
Yes o
No o
19. Answer if yes to Q18. If your organisation has received state aid during the current and preceding two financial years, please list this in the table below. Please see the Application Guidance Notes for further guidance on state aid.
Financial year ended / Body / Amount (£) / Date offer was receivedTotal (£)
Any unapproved state aid granted over the €200,000 limit may be subject to repayment with interest.
Signed by /Duly authorised on for and on behalf of /
Organisation /
Date /
Declaration
As part of our assessment process The Social Investment Business and the Cabinet Office may need to share information about your application with other organisations such as other funders who may be able to support you.
You certify that the information contained in this form and any accompanying documents is true and correct, and that you have the authority to act on behalf of the organisation and this proposal has been approved by the Trustees/Directors.
If the application is successful, the information provided by the applicant in this application will form part of a legally binding offer letter.
By completing this declaration I agree to use of this data as outlined above
Name /Position /
Organisation /
Date /
1