East Suffolk Youth Priority Action Group

Working in partnership for young people across East Suffolk

Youth Holiday Activities Commissioning Panel for East Suffolk

Grant Application Form

Please read the accompanying guidance notes carefully before completing this application, and please answer all questions as fully as possible. Please indicate if a question is not applicable.

Once completed, please return this application with all relevant supporting documents to:

or

Stuart Halsey, Active Communities Officer Waveney District Council, Riverside, 4 Canning Road, Lowestoft, NR33 0EQ

Deadline: Friday 21st October 2016 17:00 – Applications received after this deadline will not be considered.

Section A - About Your Organisation

A1. Contact Details
Contact Name: / Organisation/Project Name:
Position:
Address: / Email Address:
Telephone Number:
A2. What is the Legal Status of Your Organisation?
Please check the relevant box.
Unregistered voluntary or community group ☐
Registered charity ☐
Local branch of a national organisation ☐
Charitable company limited by guarantee ☐
Community/social enterprise ☐
School or statutory body ☐
Town or Parish Council ☐
Other – please state below☐
If you are a registered charity, please state your number:
A3. Organisation Description
In no more than 75 words, please tell us about your organisation and its aims.
A4. Does your organisation have the following policies and documents?
Please check the appropriate box.
Please ensure you submit these documents as part of your application. (Photocopies will be accepted)
Constitution/Set of rules ☐
Equal Opportunities Policy ☐
Child Protection Policy ☐
Health and Safety Policy ☐
Safeguarding Policy ☐
DBS Certificates of Main Project Leaders ☐
Public Liability Insurance ☐
What amount of cover is provided by your public liability insurance? £______
A5. How many people are involved in your organisation? The volunteer total should include volunteers who are members of your management committee or assist in delivering services.
Management Committee/Trustees
Paid staff
Volunteers/Clients/Members

Section B – Your Project/Activity

Project Name
B1. Project/activity description / What are you planning to do? Summarise here.
B2. What are the aims and outcomes?
How will these outcomes benefit young people in the local community? / What does your project/activity hope to achieve?How will this project help local young people and why?
B3. Please indicate the school holidays this activity will cover. / Please check boxes as appropriate.
Summer Holiday ☐
October Half-term ☐
Christmas Break ☐
February Half-term☐
Easter Break ☐
May Half-term ☐
B4a. Please indicate in the table how many sessions per week this activity will run, and on which day of the week? / Please check boxes as appropriate. Please note the information provided can be simply indicative – the Commissioning Panel is aware that any plans stated here may change during delivery.
Week / Mon / Tues / Wed / Thurs. / Fri / Sat / Sun
Summer 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 3 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 4 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 5 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Summer 6 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Oct HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Christmas 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Christmas 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Feb HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Easter 1 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Easter 2 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
May HT / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
B4b. How long on average do you expect each session to be? / Again this information can be simply indicative. E.g. around 2 hours in the evening.
B5. How can you evidence the need for this project or activity? / Where did the idea come from? Do you have any evidence of why the project is needed?
B6. How are young people involved in the development of this project and this application process? / How did you engage with young people in the planning of this project/activity?
B7. Tell us about the young people your activity will engage with. / B7a. How many young people do you anticipate this activity will engage with?
If possible, give as much detail as possible: e.g. 50 individuals in total, up to 20 young people per session
B7b. What age range of young people is this activity/project aimed at?
B7c. Will your proposed activity/project be open to:
Please check as appropriate
  • Existing service users only ☐
  • All young people, including those who have not previously engaged with your organisation☐

B8. How will you monitor the success of the project? / How will you demonstrate to us that the outcomes and aims stated in question B2 has been achieved, and also how will you find out what went well/less well? E.g. through surveys of participating young people etc.
B9. How will you publicise your project or activity? / In what ways will you publicise your activity to young people in the local area?

Section C – Finance

C1. What is the total amount of funding you are applying for? / £
C2. Please provide us with a breakdown of the total cost of this project. Please give as much detail as you can to support your costings. Please provide any quotes if applicable.
Item/Activity Cost and Details / Amount (£)
Total: / £
C3. Is there any match funding towards this project? Please refer to guidance notes for examples of match funding.
Source of Match Funding and Details / Amount (£) / Secured?
☐
☐
☐
☐
Total: / £
C4. Will there be a charge to the young people wishing to participate in this activity? If so, how much are you planning to charge per session? Please note the answer to this question will only form a small part of the panel’s overall assessment of value for money.
Yes ☐ £
No ☐

Section D - Declaration

This declaration should be signed by the chair person, secretary or treasurer:

I am authorised and eligible to sign this application on behalf of the organisation and declare the information included in this application is true and accurate. I understand that the information provided will be used to assess this application and subsequently to monitor the activities that the organisation has set out. I understand that in the assessment of this application the Commissioning Panel may share information contained with it with relevant partner organisations.

Full name:
Signature:
Position:
Date:
Data Protection
Some of the information provided by you will be held on a database. This means it is covered by the conditions of the Data Protection Act 1998.

an ESYPAG initiative – supported by: