Community Grant External Application Form 2017

Please complete the following information

Section 1:

Organisation or Group Name:
Address:
Are you a registered charity
Charity Number
If you are not a registered charity then do you have a constitution (if yes then please provide a copy)
Constitution attached
Contact Tel No.
Mobile No.
E-mail Address:
Website (if applicable)
Payment information /Bank details
Bank Account Name
Bank
Bank Branch Address
Bank Sort Code No.
Bank Account No.
You will need to provide a copy of your last audited annual accounts with your application or provide an explanation as to why they cannot be supplied
Audit Accounts attached / Y/N

Section 2

Funding Application

Text boxes will expand as you type*

A.  Provide information about the proposed project: Describe what the project will do and how you would use the Community Safety Partnership Grant funding – include the evidence based use e.g. why there is a need for the project and how the community will benefit. (Max 1000 words)

B.  Explain which community or group of people will benefit from or be supported by the project/activity and how the project specifically assists in the delivery of the Community Safety Partnership Priorities. Tell us the numbers of people who will benefit. Be realistic and do not over estimate.

(Max 500 words)

Have you consulted with the local community about the project/activity? Y / N
If you have answered yes, tell us who you have consulted with and why you consulted with them. What were the results of the consultation?
Are similar projects being run in Hull and your local area? Y / N
If so how will your project supplement or enhance the on-going work?
Are any other groups, organisations or partners involved in the project? Y / N
If you have answered yes, tell us what their involvement will be

C.  How will you evaluate the success of the project? What evidence will you collect to demonstrate that the local people have benefited from your project?

D.  Describe how you will implement the project

E.  Where will your project be delivered?

F.  Start Date:

G.  Finish Date:

Section 3

H.  How much will your project cost

I.  Describe how you will maintain the project

Have you applied for, or received, funding for this project from elsewhere? Y / N
If you have answered yes, please give details of the source and the amount of the funding. This should include any other council/public sector funding:
Some projects will have ongoing revenue implications for individual organisations within the Partnership for future maintenance and other running costs. If this is applicable to your project please provide details:
Please provide a breakdown of all the actual costs of the project, giving as much detail as possible. Use a separate sheet of paper if necessary.
This may include any staff salaries, fees, overheads (e.g. telephone, stationary), travel, publicity, room hire, equipment or materials.
You must supply two alternative quotes for any items to be purchased i.e. equipment, materials.
Expenditure Type / Amount
£ / Financing / Amount
£
Revenue
Capital
TOTAL / TOTAL

J.  Explain what will happen when the CSG has been spent. How will the project/activity continue? How will it be funded.

.

I/We confirm that the information provided in this form is accurate to the best of my/our knowledge. If a Community Grant is awarded, it will only be used for the purpose given and according to any conditions specified. I/we understand that after payment of the grant we will be expected to provide information on the progress of the project and proof of expenditure through agreed monitoring forms and performance frameworks.

Signature (from the person submitting the form
Position
Organisation
Print Name
Date

Part 1 CHECKLIST

Does your project or initiative help to address any of the following
Focus on tackling domestic abuse
Reduce re-offending
Reduce substance misuse
Reduce violent crime
Support victims and vulnerable communities
Ensure fewer people are involved with crime and anti-social behaviour
Ensure fewer repeat and vulnerable victims (anti-social behaviour / domestic abuse)
Ensure people experience improved health outcomes including substance misuse and mental health
Help people feel safe at home, in their neighbourhoods and the city centre
Reduce the risk of victimisation
Create an environment where unacceptable and offending behaviour is challenged and discouraged
Focus on locations where violent crime is more prevalent
Tackle community priorities
Help communities to identify and implement solutions
Improve community cohesion
Help more people into training, education, paid or unpaid work
Use an intelligence-led approach

Part 2 Equality Information

We are committed to equality and opportunity in all of our grant schemes. To help us measure whether or not we are achieving this could you please tell us about your organisation:

a)  Are most of the people involved in your organisation from Black or Ethnic Minority communities (Y/N)

b)  Do most of the people involved in your organisation have a disability? (Y/N)

c)  Would you consider your organisation to be mainly or exclusively for the benefit of: (you can tick more than one box)

ÿ  Women (including pregnant and nursing mothers)

ÿ  People who are gay, lesbian, bisexual, transgender or questioning

ÿ  Black and Minority Ethnic communities

ÿ  Refugees or asylum seekers

ÿ  Older people 50+

ÿ  Young people (16 to 25)

ÿ  Children (under 16)

ÿ  People with disabilities (including learning disabilities)

ÿ  People with mental health issues

ÿ  Other

If you ticked ‘other’, please describe the group you think benefits most from your organisation.

CSP – Community Grant Fund application form 2017 (12/10/17)