ST ANDREW HOLBORN GROUP OF CHARITIES

Application for Organisations

Please note that grants can be only considered if the aims and objectives of the organisation are for the relief of need

NAME OF ORGANISATION

NAME OF CHARITY APPLYING TO

& AMOUNT REQUESTED

St Andrew Holborn Charity

The Alexander Stafford Charity

Bromfield Education Foundation

PURPOSE OF GRANT

(15 words only)

St Andrew Holborn Charity Registered Charity No: 1095045

Alexander Stafford Charity Registered Charity No: 2306770

Bromfield Educational Foundation Registered Charity No: 312795

Grants Officer: St Andrew Holborn, St Andrew Street, London, EC4A 3AF

Tel: 020 7583 7394 Fax: 020 7583 3488

Email: website: www.standrewholborn.org.uk/Charities

1.  Contact Details

1.1 Contact person:
1.2 Address for correspondence:
1.3 Telephone number: / 1.4 Fax number:
1.5 E-mail
1.6 Website

2.  Organisation Details

2.1 Charity number (if registered): / 2.2 Year established:
2.3 Is your organisation in the area of benefit for the charity to which you are applying? Please see our map (http://www.standrewholborn.org.uk/charities/boundarymap/map.html). If not, does it provide a service to those who live in the area?
2.3.1 If you are applying for to the Stafford Charity, have your service users lived in the area of benefit for at least three years?
2.4 What are the aims and objectives of your organisation?
2.5 What services do you provide

3.  The purpose of your application

3.1 What is the reason for your grant application?
3.2 What is the outcome you hope to achieve? – Please give evidence that this is achievable
3.3 What would the impact be on your service users if this application is not successful or only partially successful?
3.4 How does this grant relate to the goals and objectives of your organisation?

4.  Your service users – Please give as much detail as possible

4.1 Who and how many will benefit from the grant you are applying for?
4.2 What is the age distribution of those who will benefit?
4.3 What will be the ethnic composition of those who will benefit? Please give % of each group to benefit where possible
4.4 How many disabled people will benefit?

5.  Finance*

5.1 What is the total cost of the proposed activity or project to which this application relates? Please attach any funding and budget outlines available.
5.2 Have you approached another organisation for funds for this project?
5.3 If so, what was their response?
5.4 Is match funding required? (No grant will be released until proof is provided that the rest of the moneys required have been obtained)
5.5 When is this funding required
5.6 What other funds have you received from other sources in the last two years and from St Andrew Holborn associated charities within the last five years?
5.7 Have you applied to one of the St Andrew Holborn Group of charities before? If so please give the name of Charity, date awarded, the amount and what the grant was used for?

*Please attach any relevant supporting documentation as you feel necessary

6.  Other details

6.1 How many people do you have working in your organisation?
Full Time / Part Time: / Volunteers:
6.2 What links do you have with other organisations working in a similar field?
6.3 How will you make sure the money is used well and what documentation/evidence will you supply to show how the activity or project related to this application has achieved its stated goals and objectives?
6.4 How many people are authorised to sign a cheque to withdraw money and what are their positions?
6.5 Please detail any material changes to your organisations activities, structures or financial position since the date of the most recent accounts;
Please provide us with the following:
1)  A copy of your organisations constitution / r
2)  A copy of the latest signed accounts / r
3)  A copy of an annual report / r
4)  An income/expenditure projection for the next year (if available) / r
5)  A copy of your most recent bank statement / r

7.  Payment information

Please provide the following information and a bank statement for verification:

7.1 Name of Bank:
7.2 Address of Branch and Post code
7.3 Account in the name of:
7.4 Bank Account No. / 7.5 Sort Code

8.  Terms and Conditions

In the following terms and conditions ‘The charity’ refers to whichever charity (St Andrew Holborn Charity, Stafford Charity and Bromfield Education Foundation) the applicant has requested funds from.

1.  The grant is for the activity agreed by the charity/ charities and a request is required if any changes are to be made. If funds have not been used in 3 months, the charity/ charities reserve(s) the right to withdraw the funds. Please inform the charity/ charities of any under spend and the charity/ charities reserve(s) the right to claim back funds, which have not been used for the agreed purposes.

2.  An evaluation report on how the grant has been spent and what has been achieved will be required by the charity/ charities no later than12 months after the grant has been awarded. The Grants Officer will also visit to obtain details of outcomes.

3.  Funds will be repaid to by the charity/ charities if they are found to have been spent negligently or fraudulently.

4.  Up to date records and accounts must be kept showing how the funds have been spent and by the charity/ charities may request to see such accounts and be provided with receipts where appropriate.

9.  Declaration

I,.………………………………………………....., am an authorised representative of

………………………………………...... (name of organisation) within which I am

……………………………………………… (Position) Date…………

To the best of my knowledge all the information I have provided is correct and my organisation agrees to be bound by the terms and conditions above.

Signed…………………………………………………..Date…………………………

8