BETTER CARE FUND REDUCING EMERGENCY ADMISSIONS AND ATTENDANCES VCS GRANTS PROGRAMME
Application Form[1]
for funding for the period 1st June 2015 to 31st March 2017
Closing date for Applications: 12thApril 2015
(Please note late applications will not be considered)
(All applications forms must be typed).
Please read the application questions carefully before completing this form and ensure all parts of the form are completed fully and that you have enclosed all the required documents.
Please read the grants criteria carefully to ensure that your organisation and service meet the identified need, criteria and service outcomes.
If you have any queries about the application form, application process or grant criteria, please contact the appropriate Officer below:
Adult Services and Ealing CCG contact:Cath Attlee ()
If you need any help in completing your application you can contact any of the following Funding workers:
Ealing CVS Funding Manager: Antony Bewick-Smith
BME Funding Workers: Matt Freidson () or Suki Kaur ( )
Completed application forms and other required documents should be sent to (preferably by e-mail):
Cath Attlee () by 12th April 2015.
If you are sending in a hard copy please send it to:
Cath Attlee, Head of Integrated Commissioning, Adults’ Services, 2nd floor, Ealing Council, Perceval House, 14-16 Uxbridge Road, LondonW5 2HL
BCF Reducing Emergency Admissions VCS Grants Application Page 1
ECCG BCF VCS Grant Funding Application
Part A About Your Organisation
1) Name of Organisation:
2) Date your organisation started:
3) Address for Correspondence:
Address:
Email:
Telephone:
Ealing address if different:
Email:
Telephone:
Web address:
4) The legal status of your organisation
Company limited by GuaranteeNo:
Registered CharityNo:
Residential Social LandlordNo:
Voluntary Organisation
Social Enterprise / Community Interest CompanyNo:
Friendly SocietyNo:
Other (please describe):
Is this a branch or subsidiary of a larger or national organisation?
Yes / No
If yes please describe:
Are you part of a federal organisation?
Yes/ No
If yes please describe:
5) Management Committee
Name of Chair of the Management Committee:
Address for Correspondence:Email:
Telephone:
6) Policy and Procedures:
Please submit copies of your policies and procedures with your application form.
Constitution / Governing Document
Protection of vulnerable adults
Equal Opportunities Policy
Health and Safety
Registration No with appropriate body/ies i.e., CQC (if applicable)
Complaints procedure
Please read the grant criteria carefully and enclose any required documentation with your application.
7) Organisation Aims and Objectives
Please provide an outline of your Organisation’s overall aims and objectives
Maximum of 100 words
8) Organisation Services
Please provide a brief outline of the key services currently provided by your organisation (including partner organisations, if a consortia bid).
Maximum of 300 words
BCF Reducing Emergency Admissions VCS Grants Application Page 1
ECCG BCF VCS Grant Funding Application
Part B About the Service
Information about the service you wish to provide. This is the most important part of the application form.
Please ensure that you complete all the questions within the form and that you submit a Service Implementation Plan.
1) Amount of funding you are applying for
2015/16 / 2016/17Revenue funding
Set up costs
Total
2) Statutory Service(s) with whom you are working in partnership[2]
List all partner organisations you are working with, both statutory and other VCS organisations.
Note:
- We need supporting documents from the lead organisation (e.g. governing documents, complaints procedures etc, not from all the partner organisations)
- The service development plan should identify clearly roles and funding for each partner organisation
Service Details
3) Is this service
New/Existing
3a) Ifit is an existing service please tell us how long it has been running and how it is currently funded:
Maximum 200 words
Service component / Funding Source / 2014/15 £ / 2015/16 £3b) Please describe if there arestart-up costs for this service?
If so, please estimate any start-up cost?
ECCG will consider payment of start-up costs on a case by case basis up to a maximum payment equivalent to three months of the annual cost of the service.
Maximum of 200 words
3c) if it is a new service please state the date when the service will be fully operational and outline the implementation milestones.
Maximum of 100 words
4a) Evidence of Health Benefit
Please provide evidence of need for the service / activities and any specific needs of service users in Ealing including the needs of “equality groups” (Question 11 below identifies the equality groups).
Maximum 100 words
4b) Service User Involvement
How will service users be involvedin the development and monitoring of the service?
Maximum of 100 words
5) How the Service will Operate
Please describe how the service will operate covering
(a) an outline of the activities / services for which you are requesting funding
(b) how these meet the grants criteria and
(c) how the services / activities will meet the needs you have identified in section 4 above.
Maximum 500 words in Total
6)The Organisation’s Experience of Delivering these Services
Please set out below
(a) the organisation’s “track record” in delivering the above activities / services
(b)the capacity and resources (e.g. premises, equipment etc.)you have to offer
(c) the expertise and knowledge, the skills, qualifications etc. of staff, volunteers and management committee members
(d) your approach to quality assurance (outline any quality assurance measures you have including accredited qualifications or working towards)
(e) your approach to participation and consultation methods with service users and how this influences service development/delivery)
Maximum of 800 words in total
7)Working with other Organisations
7a) Describe your organisation’s experience of working in partnership with other organisations to deliver services; and 7b) how will you work with other organisations to deliver the proposed services.
Maximum of 500 words in total
8) Location of the Proposed Services
Please state (a) where the activities / services will be located in the Borough and (b) which geographical areas will be served.
(a)Location(s) of activities / services:(b)Geographical areas served:
Acton
Ealing / West Ealing
Hanwell
Northolt / Greenford / Perivale
Southall
Borough wide
9)Frequency/ availability of the provision Please state timing and frequency of services/ activities
Maximum of 100 words
10)Please identify, where appropriate, your signposting and referral processes and policies.
Maximum of 200 words
11)Number of Beneficiaries Please state approximately how many people you intend to support (per annum) and how the number is worked out.
Maximum of 300 words
Number overall per annum:
How have you estimated the number of beneficiaries?
12. Who are your Service Users?
12a) Please describe the profile of your current service users (see Annex)
Maximum 200 words
12b) Are you intending to target the new service to specific cohorts of the community. If so who areyou targeting andhow will do this?
Maximum 200 words
13)Good Practice Development
(If you need assistance in completing this section you can refer to the ECN VCS Equalities Toolkit and ECN VCS Environment Charter)
13a) Volunteering: Please describe how you will use volunteers in delivering your bid and how many new volunteers you will recruit
Maximum 250 words
13b) Equalities / Community Cohesion:Please describe what actions you will take to promote equality, diversity, social inclusion, community cohesion and sustainability and meet the requirements of theNHS EDS system and the protected characteristics.
Maximum 500 words
14) Service Delivery Plan (SDP)
All organisations must submit with their application a service delivery plan covering the funding period (i.e.2015 – 2017), It is open to applicants to develop the format for this and it can be set out in tabular form. The SDP must include relevant information regarding the grant criteria on:
- Outputs, milestones and outcomes for each key activity or service for each grant criteria applied for in each year;
- How outputs and outcomes will be measured;
- An assessment and identification of risk (high, low and medium) relating to the capacity and sustainability in maintaining the activities and services and how you will mitigate them in delivering the services and activities.
Outputs should be sufficiently detailed regarding the components of the services.
Information and guidance on outputs, milestones, outcomes and risk and how to measure these is available from the funding Workers as shown at the start of the application form.
14) How will you achieve and demonstrate value for money?
Maximum 250 words
BCF Reducing Emergency Admissions VCS Grants Application Page 1
ECCG BCF VCS Grant Funding Application
15 Expenditure for the Proposed Service
Please outline all your expected expenditure for the services/activities.
Amount £1/6/15 to 31/3/16 / Amount £
1/4/16 to 31/3/17
Start-up Costs
Staff Costs
(list posts)
Volunteer Expenses
Overheads / Administration
(I.e. Rent, post, stationary, utilities etc.)
Resources
(Activities, outings, books etc)
TOTAL / £ / £
16) Additional Funding: Please set out any additional funding you estimate you will be able to contribute towards the costs of providing the activities / services for each year (ie from other funding sources) and how realistic these estimates are.
Additional funding could be from fees and charges, funding from other external sources, fund raising, sponsorship, and income generationand indicate whether it is committed / probable or anticipated with C, P or A after the figure
Additional funding source / 2015-2016 / 2016-2017£ / £
Charging
Fundraising
Sponsorship
Other grants
Other (give details)
If you anticipate any substantial changes to your expenditure for 2015 – 2016, 2016 - 2017, please set these out below.
Maximum 300 words
Declaration
When you have completed the application please sign this declaration.
I (name of representative)
being the authorised representative of: (the organisation)
Confirm that the information given in this application is correct and that the project/organisation is not established or conducted for profit.
I undertake to inform ECCG of any changes in the organisation’s circumstances that would affect this application
Signed______
Date______
Please submit completed application form (preferably via E-Mail) to: Cath Attlee ()
Or post hard copy to:
Cath Attlee
Head of Integrated Commissioning
Adults’ Services, 2nd Floor
Ealing Council
Perceval House
14-16 Uxbridge Road
Ealing
W5 2HL
On receipt of application form an acknowledgement email will be sent to you. If you do not get an email please inform Cath Attlee on 020 8825 7102
BCF Reducing Emergency Admissions VCS Grants Application Page 1
ECCG BCF VCS Grant Funding Application
Declaration from Partner Organisations
Each Partner Organisation needs to sign this sheet which must be submitted with the Application.
I (name of representative)
being the authorised representative of: (the organisation)
Confirm that my organisation is working with the applicant organisation and that the application is consistent with the grant criteria and is likely to contribute to the delivery of the outcomes required in the Grant Programme.
I undertake to inform ECCG of any changes in the partnership arrangements that would affect this application
Signed______
Date______
Supporting Comments:
[this sheet should be duplicated and completed by all Statutory Partners – applications which do not include a supporting statement from one or more Statutory Partners will not be considered.]
BCF Reducing Emergency Admissions VCS Grants Application Page 1
ECCG BCF VCS Grant Funding Application
Check List
Have you completed all questions fully?
Signed the declaration?
Enclosed copies of
Constitution / Governing Documents
Last Annual General Meeting Minutes
Committee Members and contact details
Supporting documents of legal status (if applicable)
Vulnerable Adults Policy
Equal Opportunities Policy
Health and Safety Policy
Insurance certificate
Registration No with appropriate bodies (if applicable)
Latest auditedaccounts
Partnership Declarations
Consortia Agreement
If an application is on behalf of a consortium, we will require statements from the partners to the consortium agreeing to: (a) the lead body and (b) policy and procedures of the lead body and (c) their role in the delivery of the service.
Annex
Monitoring information on beneficiaries of the activities / services (Question 12)
Ages of beneficiaries
Aged Between / Percentage of clientsMale / Female
0 – 18
19 – 24
25 – 60
Aged 60+
Ethnicity of beneficiaries
Ethnicity (Main Category) / Ethnicity (extended codes) / Percentage of clientsAsian or Asian British / Bangladeshi
Indian
African Asian
Other Asian
Pakistani
Black or Black British / Other Black African
Ghanaian
Nigerian
Somali
Caribbean
Any Other Black Background
Other Ethnic Heritage / Chinese
Afghan
Arab Other
Iranian
Iraqi
Japanese
Latin/South/Central American
Any Other Ethnic Group
Mixed / Dual Background / Other Mixed Background
White and Asian
White and Black African
White and Black Caribbean
White / White British
White Irish
Traveller of Irish Heritage
White Eastern European
White Other
White Western European
Gypsy/Roma
Disability of beneficiaries
Disability / Percentage of ClientsLearning disability
Physical Disability
Mental Health Functional
Mental Health Organic(Dementia)
Sensory Impairment
Other details of beneficiaries
low income, unemployed or living with povertydrug and alcohol dependence
Lesbian Gay Bisexual Transgender (LGBT)
homeless
BCF Reducing Emergency Admissions VCS Grants Application Page 1
[1]The application form and documents attached will be available for public inspection on the ECCG website, the Ealing Council website and the Ealing Voluntary Service Council website.
[2] Along with the Application Pack we have included a list of Statutory Service Contacts. You will need to work with one or more of these partners to develop your service proposal and each of these Partners will need to sign up to your funding application.