Funding breaks for carers and those they care for

Application Form 2015

Please read the accompanying Guidance Notes for Creative Breaks carefully. It explains the outcomes that we want the fund to deliver and what to include in your written proposal. The Guidance can be downloaded from: www.sharedcarescotland.org.uk

When to Submit

The deadline for applications to this Fund is Friday 8th May at 12 Noon. All application materials must reach the office by this time. We are unable to accept late or incomplete applications.

How to Submit

Please submit your application and supporting materials by email to:

We will acknowledge receipt of your application by email within 7 working days. If you do not receive an acknowledgement please contact us. We will use the contact email address provided in Section 1 for all correspondence relating to your application.


Assessment

Your application will be assessed by an external, trained assessor who will evaluate your application against the criteria described in the help notes. The process will involve an assessment interview by telephone. The assessor will then pass his/her assessment report to a Grant Allocation Panel (GAP) who will decide which applications will be funded. We expect to notify all applicants of GAP decisions in mid-August.

Support to applicants

We strongly encourage applicants to attend one of our application support workshops. Details of these are on our website, along with dates of our phone-in days for 1-1 information and advice - www.sharedcarescotland.org.uk

Section 1: Applicant Organisation Details

Organisation Name
Address and Postcode of Organisation
Name of Main Contact for this application
Position
Contact E-mail
Daytime telephone
Mobile
Address and postcode for Correspondence (if different from organisation address)
Are you a branch of a larger organisation? (If yes what is the name of the larger organisation?)
Website address
Please confirm you are a voluntary (third sector) organisation / Yes No
Please tell us if your organisation has been in existence less than 5 years / Yes No
Legal status of organisation Please provide Scottish Charity number and Company registration number as appropriate
Care Inspectorate Registration number

Section 2: Project Details

Project Name
Briefly and clearly describe the project for which you are requesting funding.
50 words max.
e.g. “We will provide a weekly evening social group in Kilmarnock for 15 adults with a learning disability and autism so that they can pursue their interests and make friends while their carers get a break.”
Please tell us whether you want to develop a short breaks service, or manage a short breaks fund (Time to Live) /
Service Development Time to Live
Which Local Authority area(s) will the beneficiaries come from?
Is this project new or an existing service?

Previous Funding

Please list all previous Short Breaks Fund grants and dates received, for any project in your organisation that has benefitted
Service Development applications only
Please estimate the total number of hours of service you expect to deliver with the funding.
e.g. your project will provide a club for people with dementia, 3 hours per day for 4 days per week for 30 weeks. So 3 x 4 x 30 = 360 service hours. / Number of Hours of Service
=
Service Development applications only
Please estimate the total amount of direct service hours the cared-for people will receive.
e.g. you will run the club over 10 weeks, for 2 hours each time for 10 people with dementia.
10 weeks x 2 hours x 10 people = 200 Hours / Hours for Cared-for People
=
Service Development applications only
Please estimate the amount of short break / respite hours the carers will receive.
e.g. you run the lunch club for 20 weeks, lasting 1.5 hours each time.
12 people attend the lunch club, of which 6 will have one carer benefitting and the other 6 will have two carers benefitting.
Carers benefitting: (6 x 1 carer) + (6 x 2 carers) = 6 + 12 = 18 Carers
20 weeks x 1.5 hours x 18 carers = 540 Carer Short Break Hours / Carer Hours
=
Time to Live applications only
Please estimate the number of grants you will make. / Number of grants
=

Creative Breaks outcomes: please tick the outcomes that your project will help to deliver

Carers and the people they care for will have improved well being
Carers will have more opportunities to enjoy a life outside of their caring role
Carers will feel better supported to sustain their caring role.
Carers who are less likely to ask for support (such as carers from BME communities, kinship carers, and carers of people with mental health problems) will feel better supported and more aware of sources of help
Through sharing learning and practice, there will be better understanding of the role of short breaks in supporting caring relationships, and a better understanding of the short break needs of carers and those they care for

Creative Breaks priorities: please tick any of these that apply to your project

Projects that provide personalised breaks and/or re-design services in preparation for self-directed support
Projects which will be proactive in reaching less visible and under-served carers such as BME carers, and carers from the Gypsy / Traveller communities
Projects that make a lasting difference to young adults with disabilities through building social networks, developing skills and confidence and reducing their dependence on family carers:
Projects that will reach carers and the people they care for in remote and rural areas; and/or projects that will reach carers living in areas of multiple deprivation
Projects that improve provision for people diagnosed with dementia, severe and enduring mental illness or serious long term conditions, and their carers
Projects that we can learn from. We particularly want to know about new ways of working with carers that puts them at the centre of planning, and projects that improve access to mainstream services.

Partnership working and links with local strategies and plans

If the delivery of your project involves working in partnership with other organisations, and/or if you have discussed your plans with relevant local strategic partnerships , please provide details below:

Organisation / Name of contact person/lead officer / Email address of contact person

Online Directory of Short Break Services

Is your short break service already listed on the Shared Care Scotland online directory? / Yes No

Shared Care Scotland manages an online directory of short break and respite services to ensure information about services is widely available, and to give people greater choice and control about services they access. If you currently provide a short break respite care service, we would invite you to add your service to the directory. You can read full details about signing up at www.sharedcarescotland.org.uk/service/signup.html


Section 3: Beneficiaries

We would like to know more about the people who will benefit. We appreciate you may not know precisely at this stage which groups will benefit so please make your best estimate.
A: TYPE OF CARER: / Estimated Nos.
TOTAL number of carers who will benefit
Of the total how many carers will be new to your organisation
Of the total how many will be Kinship Carers (refer to Help Notes for definition)
Of the total how many will be Young Carers (age 18 and under)
Of the total how many will be Young Adult Carers (age 19-25)
If your project aims to target any carers in the groups below, please estimate how many: / Estimated Nos.
Black or Ethnic Minority Carers
Carers living in remote, rural areas (see guidance notes page 8)
Carers living in SIMD 15% areas (Scottish Index of Multiple Deprivation: see guidance notes page 8)
Gypsy/traveller Carers
B: PEOPLE BEING CARED FOR / Estimated Nos.
TOTAL number of cared-for people to benefit
Adults (21-64) / Estimated Nos.
Of the total, how many have a physical disability
Have a sensory impairment
Have a mental illness (excluding dementia)
Have a learning disability
Have alcohol or substance addiction
Have dementia
Have autism or other developmental disorder
Have a long term illness, disease or condition
Other condition – please define
Older Adults (65 +) / Estimated Nos.
Of the total, how many have a physical disability
Have a sensory impairment
Have a mental illness (excluding dementia)
Have a learning disability
Have alcohol or substance addiction
Have dementia
Have autism or other developmental disorder
Have a long term illness, disease or condition
Other condition – please define
C: VOLUNTEERS / Estimated Nos.
If your project will involve volunteers please estimate how many

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Section 4: Budget for Proposed Project

Please list all planned expenditure for your project, providing as much detail as possible to explain your calculations. Please note that we prefer that organisations, where possible, increase the hours of existing p/t or sessional staff rather than create new posts which may be difficult to sustain when the project funding comes to an end.

Proposed Expenditure / Amount / Details / Office Use Only
Salary Costs (list all posts being applied for)
NI Costs (list)
Pension Costs (list)
Recruitment of Staff
Staff Travel and Subsistence
Sessional Staff Costs (non-salaried posts)
Volunteer Expenses
Proposed Expenditure / Amount / Details / Office Use Only
Staff Training
Volunteer Training
Office Costs (stationary, postage, heating/lighting, telephone etc)
Office Equipment or Furniture (please detail)
Specialist equipment (please detail)
Grants to Carers (Time to Live)
[1]Management and Supervision (please detail)
Transport costs (where transport is required to access a short break)
Other (please detail)
TOTAL EXPENDITURE

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Please use this box to tell us if and how you plan to raise the income for the above expenditure from any other sources (include in-kind if this is relevant).

Project Income
Grant requested from the Short Breaks Fund
Other Income Source / Amount / Confirmed/Pending
If pending, please indicate in ‘further comments’ text box below when you expect to hear the outcome.
Confirmed Pending
Confirmed Pending
Confirmed Pending
TOTAL PROJECT INCOME (including grant requested from SBF)

What will be the impact on your ability to deliver this project if you are unable to secure the total amount of funding from other sources?

Please tell us how many months running costs your organisation has in reserves. Please explain if your unrestricted reserves are less than 3 months or more than 6 months.

Please use the text box below for any further comments you would like to make about the project income and expenditure. If you have included management costs in your application please let us know how these were calculated.

Section 5: Project Plan

Please refer to the Guidance Notes for further information on completing your Project Plan.

The length of your project plan should not exceed 4xA4 sides. Applications for grants of less than £10,000 should not exceed 3xA4 sides

The project plan should be clearly marked with your project name on each page.

Insert your Project Plan here


Section 6: Contact details and Compliance

ü  I confirm that the information provided for this application is true and accurate. I also confirm that my organisation meets the eligibility criteria and has the legal power to set up and deliver the work set out in this application.

ü  I confirm that we have the necessary policies and procedures in place for working with under 18’s and vulnerable adults – where these are applicable to the application.

ü  I confirm that I have authority from my organisation to make this application.

Main Contact for Application
Name
Designation
Date
Chief Officer or Chair of Applicant Organisation/Service
Name
Designation
Date
What is the name of your organisation? (from Section 1)
What is the name of your project? (from Section 2)

Please note: we do not require a signature at this stage but if your application is successful we will require an authorised Officer/Director to sign a binding agreement to comply with conditions of grant.


Section 7: Referees

Please provide the names of two referees we can contact who will support your application. Referees should be someone who is familiar with your work, but is not directly employed by or affiliated with your organisation.

Reference 1
Name
Organisation
Email
Telephone
Relationship to applicant/ organisation
Reference 2
Name
Organisation
Email
Telephone
Relationship to applicant/ organisation


Section 8: Enclosures

Please tick all documents you are sending to support your application.

Project Plan – included in your application

Copy of latest financial statement/ annual accounts

Job Description of any post included in your project budget

Copy of Constitution

Please let us know of other documents available to support your application. (Please do not send them at this time, but we may request to see them at a later date.)

Don’t forget:

Please send your completed application to:

By: 12.00 noon, Friday 8th May 2015

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[1] Please limit this figure to 8% of combined salary and sessional staff costs, excluding NI and Pension costs.