Section 0 Grant Type & Amount

GRANT APPLICATION FORM

SECTION 0 GRANT TYPE & AMOUNT

0.1Please indicate which grant you are applying for:

Project Viability GrantProject Development Grant

SECTION 1 ABOUT YOUR ORGANISATION

1.1Has your organisation applied to us before?

Yes/No

If yes, please enter your client ID.

1.2Enter the name of your organisation:

1.3Year established:

1.4What is your organisation's principal address?

If your organisation is a company this should be its registered office.

Name

Street

City/Town

County

Postcode

1.5Website address (if you have one):

1.6What is the legal status of your organisation?

Your organisation must have a constitution and be incorporated. You will be asked to upload your organisation's governing document to support your application (see checklist item 1). If you sent this with a previous application and no changes have been made to it since then you do not need to send it again.

DROP DOWN LIST:

Charitable Incorporated Organisation (CIO)

Charitable Company Limited by Guarantee

Not-for-private-profit Company Limited by Guarantee

Community Interest Company (CIC)

Community Benefit Society

Town/Parish/Community Council

Other (please state) ______

1.7Enter the relevant registration number(s):

Charity numberxxxxxx

Company numberxxxxxx

Financial Conduct Authority Number xxxxx(for Community Benefit Societies)

1.8Is your organisation a member of any national networks or umbrella organisations?

Name:

1.9Briefly describe your organisation's main purpose and regular activities.

FREE TEXT BOX / WORD LIMIT = 250

1.10Is your organisation VAT registered?

Yes/No

If yes, please provide your registration number: xxxxxxx

If you are VAT registered you should check with HM Revenue & Customs () to find out if you can reclaim any value added tax.

1.11If you are applying as the lead organisation in a partnership, enter the name and address of the partner organisation(s):

Name

Street

City/Town

County

Postcode

Website:

For partnership applications, a lead applicant must be nominated and it must be a not-for-profit organisation. You must provide a signed partnership agreement indicating the involvement of each partner and how the project will be managed (see checklist item 20).

1.12Please provide the details of two people, either or both of whom we can contact to discuss the application and for ongoing grant monitoring purposes:

Contact 1

Name:

Position in organisation:

Phone number 1:

Phone number 2:

E-mail address:

Contact 2

Name:

Position in organisation:

Phone number 1:

Phone number 2:

E-mail address:

1.13Enter your organisation's bank account details:

Bank name:

Account name:

Account number:

Sort code:

If your application is successful the grant will be paid directly into your organisation's bank account by electronic transfer.

SECTION 2 ABOUT THE BUILDING

2.1Enter the name and address of the project building:

Name

Street

City/Town

County

Postcode

Project website (if there is one):

2.2Have you applied to us before for this building?

Yes/No

If yes, enter the previous application reference number:

2.3Does your organisation own the building?

Yes/No

2.4If owned by your organisation, what is the nature of the ownership?

Freehold

Leasehold - state how many years remaining:

When did you acquire the freehold or enter into a lease of the building?

Date: DD/MM/YY

2.5If not owned by your organisation, who owns it and what are your plans for acquiring it?

Local authority

Charity

Private

Not known

Other (please state) ______

Name of owner (if known): ______

Likely cost of acquisition: £______

Plans for acquisition or additional details on ownership

FREE TEXT BOX / WORD LIMIT = 200

We will need to see evidence that your organisation has a realistic chance of being able to acquire the building and that you will have sufficient access to be able to carry out the development work. This could be a letter from the owner indicating a willingness in principle to transfer ownership or a statement from the local authority confirming that it is prepared to use enforcement action if necessary to secure ownership and transfer the building to your organisation (see checklist item 5).

If you are intending to acquire the building through the Community Right to Bid process, you should explain what stage you are at. If you have invoked your Right to Bid you should state the end date of the moratorium on sale on the open market.

Ideally you should seek to obtain the freehold of the building or a long lease of at least 25 years. As a minimum we will accept a lease with at least 10 years left to run following project completion.

2.6Is the building listed, scheduled or in a Conservation Area?

Listed

Scheduled

Conservation Area

If yes, please enter:

Grade/Category:

List Entry number: ______

Conservation Area name: ______

2.7Is the building on an 'at risk' register?

Yes/No

If yes, please enter:

Name of register: ______

Reference number:

You can find out if the building is on one of the national heritage at risk registers by searching the relevant website (see below) or your local authority may maintain a register.

England:

Wales:

Scotland:

Northern Ireland:

2.8Is the building listed as an Asset of Community Value?

Yes/No

If yes, please enter:

Reference number:

2.9What condition is the building in? (See guide below)

Good

Fair

Poor

Very bad

If a condition survey or similar report has been completed recently you will be asked to upload a copy (see checklist item 9).

2.10Please provide a brief description of the building, its history of use and value to the local community. If more than one building is involved in the project, please give details here. .

FREE TEXT BOX / WORD LIMIT = 400

SECTION 3 ABOUT THE PROJECT

3.1Describe the development work you want us to support with this grant.