THE INNOVATION FUND FOR ENGLAND

APPLICATION FORM

Organisation Name:
Lead contact name:
Role in organisation:
Address for correspondence:
Postcode:
Contact tel no (landline): / Contact email:
Please provide a summary of the main aims, activities and local demographic information relevant to your organisation/young carers service. (200 words max)
How many workers are there within the organisation?
Full time / Part time / Sessional workers / Regular volunteers
Where will the majority of the project activities take place? / Which England government region will the project activities take place in?
How many young carers will the project aim to support?
Please use the boxes below to specify the age groups of the young carers to be supported.
5 – 10 / 11 – 14 / 15 – 18 / TOTAL (this should match the figure above)
What is the total amount of the application?Maximum £45,000 / £
Please broadly outline what the project will do. This should include what the main aims and outputs of the project are and make clear reference to how the project will alleviate excessive and harmful care giving by the targeted young carers. (250 words maximum)
Please do not use jargon or abbreviations as a wider stakeholder group including young people will be reviewing the information as part of the selection process.
Is this an expansion of current activity or a pilot of a new activity within an existing project? Your answer should include an explanation of how the proposed activity will fit in with your organisation’s current service provision. (150 words maximum)
Please provide a brief outline of the key activities that will take place by quarter in the spaces provided below:
April 10 – June 10 / July 10 – Sept 10 / Oct 10 – Dec 10 / Jan 11 – March 11
e.g. develop marketing materials / e.g. further meetings with other agencies / e.g. review meeting with project partners / e.g. implement exit strategy
Will any of the funded work be carried out by another party? If so, please provide their name(s), main contact details and outline of the work they will undertake.

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Please complete the table below to demonstrate to the assessment panel the objectives, related outcomes and outputs you expect to generate from the proposed project.

Aims
These are the prescribed aims of the proposed work. / Objectives
Please provide up to three objectives related to each specific aim / Output target
These are activities that demonstrate the work the project does and show progress towards meeting specified aims. / Outcome indicator
These will demonstrate changes that take place as a result of the proposed project, showing progress towards meeting specified aims. / Named lead responsible
Increase the resilience of young carers who are in excessive or harmful caring roles / e.g. provide direct support to young carers / e.g. 20 young carers attend weekly peer support group / e.g. 85% of attendees report increased self esteem / e.g. Young carers support worker
Increase the involvement of statutory and other agencies in reducing the amount of excessive or harmful caring roles undertaken by young carers
Increase the involvement of extended family and other networks in reducing excessive or harmful caring roles
Increase knowledge, skills and resources available to the sector in order to reduce the amount of excessive or harmful caring undertaken by young carers.
Please use the spaces below to tell us about the roles that will be required to deliver the funded project.
Job title / Hours per week / Salary (£) / New or existing role / If new, how will this fit in with current structure?
All funded projects will be expected to use specific outcome measurement tools in their funded work with young carers and wider family networks. In addition to this, what internal methods will your organisation adopt to monitor and evaluate the funded intervention as a whole?

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Please use the spaces provided to outline the need(s) your proposed project will address, providing appropriate supporting evidence.
Identified need / Related evidence
What ‘added value’ will this proposed project bring to a: the sector and b: your organisation
e.g. explain what will be learned from your proposed approach.
Added value to the sector:
Added value to your organisation

Please provide a budget for the proposed project, giving a breakdown of the cost of each aspect of the work.

Item description / Total cost / Income from other sources / Total requested from The Princess Royal Trust for Carers
Total expenditure proposed / Total Income from other sources / Total requested from the Trust
£ / £ / £
Please use the space below to describe the sustainability of the project and/or how the organisation will manage an effective exit strategy.

All applications must be endorsed by an independent professional contact who knows the value and quality of your organisations work. This could be a project partner (previous or ongoing), people who have worked with you in the past and/or connected young carers services. This should not be someone who has made personal use of your services, board/committee member or family member.

This person will be contacted before any grant award is made and will need to be available for the Trust to contact in early March 2010.

Name:
Address:
Occupation: / Phone number:
Email address:
Please describe the length and nature of your relationship with this organisation.
What is your assessment of the quality of their current service provision?
What is your assessment of their capacity to manage and deliver the project detailed within the application form?

Referee declaration:

I confirm that the information provided within my statement is true and accurate. I know of the organisation in a professional capacity and have knowledge of the work that the organisation do.

Signature: ______Date: ______

PRINT NAME: ______

This form should be signed by a person who is authorised to sign on behalf of the Centre (e.g. Chair, Treasurer, Chief Executive Officer).

I certify that the information given in this application to The Innovation Fund, is true and accurate and confirm that the enclosures (which are referred to on the checklist on the back page of the application form) are current, accurate and adopted or approved by the organisation.

The Centre’s insurance covers the proposed activities and all volunteers and employees working with carers. If successful, our organisation is willing to share resources and information about the funded work with The Princess Royal Trust for Carers and will do so within the timescales set for the return of monitoring and evaluation information. We accept that The Trust may use the name of our organisation and the funded project in reports and publicity materials.

Signature:______

PRINT NAME:______

Position:______

Date:______

Please submit the following attachments with the application form. Application forms received without these attachments will not be accepted.

  1. Signed constitution/memorandum and articles of association
  2. Current certificates of Public and Employer’s Liability Insurance
  3. Last financial year’s signed audited accounts (or income/expenditure statement if you do not produce accounts). You may also send your Annual Report if your organisation produces one.
  4. Organisational budget for the current financial year, showing income and expenditure
  5. Child safeguarding policy or if applicable safeguarding vulnerable adults policy and procedures
  6. Equal opportunities policy
  7. Job descriptions for any roles that will be funded by the Innovation Fund
  8. Copies of local research/evaluation reports that contribute to your evidence of need(please only send paper copies if you were unable to provide an electronic link in your answer above).

We cannot accept applications by e-mail or fax so please return your completed formby post to:

Grants Team

The Innovation Fund

c/o The Princess Royal Trust for Carers

14 Bourne Court, Southend Road

Woodford Green, Essex, IG8 8HD

Applications should be received to the Trust no later than FRIDAY 29th JANUARY 2010.

Charity no: SCO15975

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