CCGs/Macc
Mental Health and Wellbeing of People with Mental Health Problems
GRANT APPLICATION FORM
ContentsIntroduction and Can I Apply?
Section 1: About you
Section 2: About the activities
Section 3: Budgets and finance
Section 4: Management
Section 5: Declaration
Final Checklist
Feedback
Deadline: 4pm, Friday 14 October 2016
Introduction and can I apply?
Please read the grant application guidance before you continue. This will help you to complete all sections of this application form correctly.
We’ve given a word limit for some of the questions in this form. We will only look at the information you give us within this word limit.
This application form is for grants of £1,000 to £10,000 to be used within a maximum period of 18 months. If you are applying for more than one grant you must use a separate application form for each one.
Can I apply?We can only accept applications to this programme from organisations that meet the criteria below. Please use the checklist to make sure you are eligible to submit an application.
Is your organisation one of the following?
· unincorporated association, incorporated association, trust or company and are set up and registered as a charity
· an unincorporated association set up as a voluntary or community group
· an industrial and provident society
· a community interest company
· a not for profit company limited by guarantee
· a community benefit society
Does your organisation have a high level of connection with other organisations working within one or more Manchester neighbourhoods or is your organisation working in partnership with one? Alternatively is your organisation a voluntary sector IAPT provider?To apply for this grant your organisation must have and be able to produce when asked:
a safeguarding policya health and safety policy and/or procedures
accounts, or an income and expenditure sheet
a bank account in your organisation’s name with at least two signatories
evidence (e.g. minutes) of board / management committee meetings in line with your constitution
a list of board / management committee members including their roles (minimum of 3)
a governing document (i.e. constitution)
relevant insurance
IMPORTANT – if you have not been able to tick all the boxes above, we won’t be able to consider your application and you should not fill in the rest of this application form!
Section 1: About you
1.1 Details of you and your organisation
Name of organisation
Address of organisation including postcode
Organisation’s website and / or social media addresses (if applicable)
Main contact person / Name
Role
Contact address (if different to organisation address)
Telephone number
Email address
Second contact person / Name
Role
Contact address (if different to organisation address)
Telephone number
Email address
Is your organisation incorporated? / Yes No
What is the status of your organisation e.g. charity
Please supply any relevant registration or reference numbers. / Name / Reference/Number
Date your organisation was established
1.2 Tell us about your organisation’s vision, values, links and activities. (200 words)
The type of work you have done, who you engage with, what outcomes you have achieved, links in neighbourhoods.
Section 2: About your activities
For what are you applying for funding? Tell us all about your proposed activities, why they are needed and how they are going to make a difference.
2.1 Name of activities2.2 Tell us about your proposed activities. (400 words)
What you plan to do, who with and how. Include your main activities. Be as specific as possible and include numbers where appropriate. Your activities must support at least one of the objectives of the grant programme.
2.3 How do you know there is a need for your activities? (300 words)
What work have you done to identify the need, from engagement with people or from research or national / local trends? Tell us what made you decide these activities are needed.
2.4 Who will benefit from your activities and how will they be involved in developing and running them? (200 words)
Which individuals and / or communities are being engaged, and involved. People might receive a service, and they might also be involved in setting an activity up and running it. Let us know who will be doing what.
2.5 Activities coverage
Which neighbourhood(s) will your beneficiaries mainly come from? If more than 80% of your main beneficiaries are likely to come from one neighbourhood then tick only that box. Do not tick a box if less than 10% of your main beneficiaries are likely to come from that neighbourhood.
1. Cheetham and Crumpsall
2. Higher Blackley, Harpurhey and Charlestown
3. Miles Platting, Newton Heath, Moston and city centre
4. Ancoats, Clayton and Bradford
5. Ardwick and Longsight
6. Chorlton, Whalley Range and Fallowfield
7. Gorton (north and south) and Levenshulme
8. Moss Side, Hulme and Rusholme
9. Wythenshawe (Baguley, Sharston Woodhouse Park)
10. Wythenshawe (Brooklands) and Northenden
11. Old Moat and Withington
12. Didsbury (west and east), Burnage and Chorlton (Chorlton Park)
2.6 Objectives
Tick at least one the objectives of the grant programme your activities will support.
1. to increase the social inclusion within their neighbourhoods of people with serious and enduring mental health problems
2. to increase the take-up of Improving Access to Psychological Therapies (IAPT) programme services among communities that finds them difficult to access
3. to increase the level of support offered to people with mental health problems who find it difficult to access existing services in their neighbourhoods
Only complete 2.7 if you are applying under objective 2
2.7 IAPT ProviderIf you are applying under objective 2 then please state which IAPT provider you will be working with
2.8 What key outcomes will your activities achieve?
These must closely relate to the objectives you ticked above and should be no longer than 30 words. Please check the guidance to ensure that you are clear about how an outcome is defined in this application.
Outcome 1
Outcome 2
Outcome 3
2.9 Describe how you will meet the monitoring requirements of this grant (including monitoring the outcomes you have identified above). (200 words)
What will you keep records of, what systems or approaches will you and who will be involved.
Section 3: Budgets and Finance
3.1 What is the total cost of your activities?Total Cost
£
3.2 How much money are you requesting from us?
£
3.3 If the grant amount requested is less than the total cost of the activities identify where the difference will come from and whether you have secured this funding
We do not require matched funding but value the ability of the voluntary and community sector to bring additional funding to the city.
3.4 Complete the table below showing expenditure per year directly related to this application e.g. staffing, rent, stationery, equipment. If you include running costs, itemise these.
Expenditure Item / £
Total
3.5 How have you worked out your costs? (200 words)
Explain the thinking behind your costs and how they represent good value. Where you have included a contribution to core costs then you need to explain how this has been worked out
Section 4: Management
4.1 How will you ensure the successful delivery of these activities? (300 words)
We want to know about your management approach and previous experience of managing similar activities successfully
4.2 Explain how you will ensure the safety of people who use services, or work or volunteer for your organisation. (200 words)
Safeguarding of vulnerable adults and children is a priority for us. We need to know that all organisations that get grant-funding are actively protecting vulnerable people
Section 5: Declarations
5.1 Data protection
Macc has duty of care in how to handle your personal details in accordance the Data Protection Act 1998, which came into effect on 1 March 2000. Its purpose is to protect the rights and privacy of individuals and to ensure that personal data are not processed without their knowledge, and, wherever possible, is processed without their consent.
The Act requires Macc to register the fact that we hold personal data and to acknowledge the right of ‘subject access’ – voluntary and community group members and staff must have the right to copies of their own data.
Macc will not use data for a purpose other than those agreed by data subjects (voluntary and community group members, staff and others). If the data held by Macc are requested by external organisations for any reason, this will only be passed if data subjects (voluntary and community group members, staff and others) agree.
Also external organisations must state the purpose of processing, agree not to copy the data for further use and sign a contract agreeing to abide by The Data Protection Act 1998 and Macc Data Protection Policy.
Macc will monitor the data held for our purposes, ensuring we hold neither too much nor too little data in respect of the individuals about whom the data are held. If data given or obtained are excessive for such purpose, they will be immediately deleted or destroyed. In this instance, those applicants who have not been successful, their application forms will be destroyed or deleted as appropriate.
All individuals that Macc hold data on have the right to:
• be informed upon the request of all the information held about them within 40 days
• prevent the processing of their data for the purpose of direct marketing
• compensation if they can show that they have been caused damage by any contravention of the Act
• the removal and correction of any inaccurate data about them
5.2 Data protection requests
If Macc receive requests for information from, for example, debt collectors, Inland Revenue or other parties a response will not be made to any such telephone requests. To be consistent and to ensure the validity of the caller Macc will always ask for such requests in writing on the appropriate headed paper. Exceptionally, it may be appropriate to respond to a caller, but checks must be taken such as calling them back on a known number.
All requests for information and the responses given will be kept in an appropriate place – preferably the personal file. Should verbal requests have been answered a record of the request and the response given will be noted and retained on file.
☐ Please tick the box to confirm you have read and understood Macc’s data protection policy.
☐Please tick this box to provide your permission that you are happy for Macc to share your information with appropriate parties for the purpose of this funding programme.
5.3 Declaration
I declare that the information given on this application form is accurate to the best of my knowledge and that I am authorised to submit this application.
I understand that I must notify Macc of any significant changes to the application and that misleading information can invalidate this application.
Signatory one
This must be the main contact named above.
I understand you may contact me during assessment and I confirm I am authorised by the organisation for this purpose and that you may rely on any further information supplied by me.
Name
Position
Date
Signatory two
This should be the chair or person of similar authority in your organisation. This person must be different to signatory one.
I confirm this application has been authorised by the management committee or other governing body.
Name
Position
Date
Final Checklist
Before sending us this form please check
You have answered every questionYou have signed and dated the form
Please return this form to Macc by email via .
Please ensure that you receive confirmation by email or in writing that your form has been received. If confirmation is not received then Macc has not received your form.
This form must be submitted before 4pm on Friday 14th October - we will not consider applications submitted after this deadline.
Feedback
It is not obligatory to fill in this part of the form and your answers to this section will not affect the outcome of your application. However, we value your feedback and will use it to improve our grant processes in the future.
1. How did you hear about this grant programme?
2. Did you have all the information you needed to complete the form?
Yes No
3. Was the application form easy to use?
Yes No
4. If you answered no to either of the questions above then please explain how the application form and information could be improved?
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