Sport and Physical Activity Grant Fund

‘Active Together’

Application Form

Organisation name
Project name
Application Number (for internal use only)
Name of your councillor(s)

Section 1

Your contact Information

Main contact details

1.1Please fill in the following details about the person in your organisation who will be the main contact for your application. We will contact this person to discuss your application in more detail should we need any further clarification.

Name of main contact

Title / First name / Surname
Position in organisation
Name of Organisation
Address for correspondence including postcode
Postcode

1.2Please enter your telephone number(s) and e-mail address (if applicable)

Daytime
Telephone number
Mobile number
E-mail address

1.3Please provide the name and email address of your main publicity and promotion contact so a promotional information pack can be sent to them to help manage this should your application be successful.

Name: / Email address:

1.4What is the legal status of your organisation (tick only one box)

Parish / Town Council
Company limited by guarantee / Company number
Company limited by shares / Company number
Charitable Trust / Charity number
Unincorporated organisation /
Not for profit organisation

1.5 If your organisation is a branch or division of a larger organisation, please tell us which one.

1.6What are the current activities of your organisation and how are these managed?

Please note:

If you run an activity for children under the age of 8 years if age you may need to meet Ofsted Early Years regulation requirements.

1.7Please tick if your organisation is on the OfstedEarly Years Register and /or Childcare Register

The Early Years Register URN

The Childcare Register

Section 2

Your local county councillor

2.1Please give the name of your local county councillor and the amount you are applying for. If you are applying to more than one division for funding please list below each councillor and the amount of funding being applied for from each divisional allocation. Your councillor can be found by visiting the county council web pages

Name of member(s) / Amount of funding applied for

Section 3

Purpose of your application

3.1Please be specific as this helps to ensure that any grant is applied for the intended purpose. A summary of Need, Purpose, Means of Delivery, Community Benefit and Expected Outcomes should be included here.

Overview of project(Need, Purpose, Means of Delivery, Community Benefit) (500 words)
Expected Outcomes (200 words)
How will your project be sustained after this funding has been spent (100 words)
Is your project aimed at a particular group e.g. children, older people, disabled people, ethnic group

3.2Does your project involve improving/altering any land or buildings? Yes No

If the answer to the question above is yes, please include the name and address of the land or buildings involved in your project in the box below?

3.3Has the owner given their consent to your project? Yes No

3.4Who will be responsible for any continued maintenance of the project if required?

3.5Have all consents, permissions been given to allow your project to proceed? Please provide details below to include any that are still pending waiting a decision.

3.6Please enter details of the start and end date of your project

Project start date

Project end date

Section 4

What is the total cost of your project?

4.1Enter the total cost of your project below

£

4.2Please detail how the money you are applying for will be spent e.g. a total of £2000 might be split as follows:-

Costs / Description / Item / Number / Total £
Staff costs / Sports Coaches / 2 @ £20 each per session – 10 sessions / £400.00
Premises costs / Room Hire / 10@ £30 per session / £300.00
Marketing / Leaflets
Posters / 1000
100 / £150.00
£50.00
Equipment / Bibs
Footballs
Goal Posts / 20@ £5 each
20@ £10 each
2@£400 each / £100.00
£200.00
£800.00
TOTAL / £2000.00

4.3If you are applying for funding that is less than the total cost of your project, have you already raised the balance? (please tick)

Yes No

Important We will not be able to release the grant until the balance has been raised or secured and applications asking for immediate funding in these circumstances will normally be returned. If you have secured any additional funding we will require you to send documentation to confirm this i.e. details of how and from where the balance will be met.

4.4If you answered No to the question above, how much have you raised and when do you expect the balance to be raised by?

How much has been raised so far / £
Date balance is expected to be raised by / £

4.5Please indicate if you intend to implement a charge for your activity

Yes No

If yes, please provide details of the charges

Section 5

Certificationplease read the following paragraphs carefully.

We certify that the project details given in sections 1, 3 and 4 are correct and that the proposed grant will be spent on that project.

We undertake with the council that if a grant is made towards the project, the grantee will comply fully with all the conditions set out in this documentand the accompanying guidelines.

DELETE one of the two following paragraphs option i) or ii)

Your application will be returned to you for further consideration if this is not done. Immediate payment will not be made if any balance of funding necessary for the project to go ahead will remain outstanding.

i) We certify that the project will proceed within 12 months of payment of the grant and we apply for immediate payment.

OR

ii) We certify that the project will not proceed until we have secured all the necessary funding for the project and that we will notify you in writing when payment is required, with evidence of the other funding we have obtained.

E-signature of applicant (this must be the person whose name and address is given in paragraph 1.1).

(Please provide your e-signature)______

Name (please print) ______

Date ______

If your application is successful you may be asked to submit the following documentation. Please tick that you are prepared to provide us with:

□A copy of the constitution of your organisation (if applicable)*

□A copy of your latest statutory accounts or approved management accounts*

□A copy of your safeguarding policy and/or an outline of your procedures if your project involves working with children or vulnerable groups

□A copy of your equal opportunities policy/or an outline of your procedures

□Confirmation of any additional funding you have securedthat is required to enable your project to proceed (if applicable)

□Any other information/documentation requested in support of your application

* If submitting an application for £5000+, including this information at the same time will help speed up the grant award process if your application is successful.

Member declaration

By submitting this application the councillor confirms that the proposed application:
  • is within their electoral division budget allocation;
  • is consistent with the Council's policies and objectives;
  • will not give rise to an on-going financial commitment;
  • will not be used for hospitality or gifts
And that they have:
  • disclosed any pecuniary interest in the proposal
  • disclosed any other interest in the proposal
If the project is being supported by more than one councillor please ensure all councillors have provided an e-signature
E-signature: Date:
E-signature: Date:
Please forward by email to

Thank you for completing this application

Please make sure you have completed all of the sections. All applications must be submitted to the relevant councillor(s)