CashBack for Communities: Small Grants Scheme
Please read the guidance notes carefully. You must complete all sections of the form.
Section 1 – Youth Group DetailsName of Youth Group:
Contact Name:
Position in Youth Group:
Correspondence
Address:
/If this is your personal address please place an X in this box
/Postcode:
/Day Tel:
/ /Evening Tel:
/Mobile Tel:
/ /Email:
/Local Authority:
/Youth Group’s website:
/Postcode of the regular meeting place of your Youth Group:
/Top of Form
Are you applying for a:
Start up Grant? (max £1,000)
/ /Programme Grant? (max £2,000)
/When was your group established?
/ /If your group is not yet established, when will it start?
/Youth Scotland membership number: 350 _ _ _ _ _
(please get in touch with Youth Scotland if you are unsure of your number)Bottom of Form
For office use only:Reference
Number / Grant
Requested / Grant
Awarded / Eligibility
Checked / Monitoring
Report due / Monitoring
Report received
Section 2 – About the Proposed Activities
Tell us what you want the funding for and why?
How many young people will benefit from this funding?
Age Group / Male / Female / TotalsUnder 10
10 - 13
14-16
17-19
20 & over
Totals
Please note: CashBack funding is aimed at young people aged between 10 and 19 years of age. However, consideration will be given to applications where a small percentage of the young people that will benefit from this grant are in either the under 10 or over 19 age range
What services/ activities does your Youth Group currently deliver?
Current staffing of your Youth Group:please provide approx. numbers
Volunteers / Sessional staff / Part time members of staff / Full time members of staff
Please describe the proposed activities and/or events for which you are applying for funding
Is this Activity new? / Yes / No
Proposed staffing of your activities/ event:
please provide approx. numbers
Volunteers / Please note this fund will only support activities and events that are volunteer led and delivered
How many of these will be new volunteers?
What is the estimated total number of hours that each volunteer will spend on the funded activity/ event? no of hours ( ) x no of volunteers ( ) =
When do you expect your project to start? / When do you expect your project to finish?
How have you identified the need for this project?
How have you consulted young people and what did they say?
How will you record what you have delivered and the difference it will make?
What impact will this funding have?
e.g. on young people, on workers/ volunteers within your group, on the local community
Section 3 – Finance and Budget
Item of Expenditure / Estimated Costs
£
Total (A) / £
LESS income from other sources – if applicable (B) / £
Grant requested (C) / £
Note: A - B = C
If you have attracted income from other sources ((B) above) please tell us about this below.
Income from other sources (B)(if applicable) / Is the funding confirmed? / Amount
£
Yes/No
Yes/No
Yes/No
Yes/No
£
Have you previously received a CashBack Small Grant? / YES / NO
If yes, have you returned your End of Project Report form? / YES / NO
Please note that if you have previously had a successful grant, we are unable to
assess your application until you have returned your report form
Section 4 – Signed Statements
Statement to be signed by applicant:
To the best of my knowledge the information given on this form gives a true and accurate account of the organisation’s work and needs. I confirm that this application will enable the youth group to grow local provision for young people by providing either the start up costs of a youth group or the costs (or part of the costs) of a particular programme of activity
Signature:
/ /Date:
/Statement to be signed by a member of the youth group’s management committee or a senior volunteer:
Your Name (in block caps):
Address:
Your Organisation:
/ /Work Tel No:
/Mobile Tel No:
/Position Held in the Organisation:
/ /Home Tel No:
/Email Address:
/Section 5 – Checklist
Answered all the questions on the application form?
/ YESApplication is signed in person by group leader?
/ YESApplication is signed in person by member of management committee or Senior Volunteer?
/ YES / /Included your latest accounts (if programme application) or bank statement/bank details (if start up application or programme application for groups that have been running less than 12 months)?
/ YES / /Data Protection
The partnership of six organisations are aware of their responsibilities in ensuring that the data you have provided as a result of this application is secure. We confirm that we will only use this data to fulfil our duties in relation to this grant programme. As this is Scottish Government funding it is however subject to the provisions of the Freedom of Information (Scotland) Act 2002 and we may have to provide information to fulfil this obligation.
Personal addresses are not subject to Freedom of Information so it is important that you tick the box on the front page if you are using your personal address for correspondence.
I confirm that I have read the above information regarding Data Protection andthe Freedom of Information Act. / CHECK BOX IF YES
Please return this application to:
Youth ScotlandBalfour House
19 Bonnington Grove
Edinburgh, EH6 4BL
Tel: 0131 554 2561
Email: