PROJECT TITLE: APPLICANT DETAILS: YOUR ORGANISATION ...
HELENA HOMES COMMUNITY FUND Application Form
PROJECT TITLE: Please give a title to the project or activity you are carrying out (This is not the name of your group)
Please tick which resident priority you are applying under 1. Clean & Green □
2. Welfare Reform
□
3. Health & Wellbeing
□
4. Anti-Social Behaviour, Crime and Safety
□
APPLICANT DETAILS: Name of Organisation:
State the name of your group
Name of Contact Person:
State the name of the person responsible for this funding application
Address of Contact:
State the address to where all correspondence should be sent
Postcode:
Provided a full postcode
Telephone:
Provide the phone number the applicant can be contacted on
Mobile:
Provide the mobile phone number the applicant can be contacted on
E-mail:
Provide an email address where the applicant can be contacted on
YOUR ORGANISATION: Please tick the box which indicates the status of your organisation Please tick one Community Group Voluntary Group Registered Charity Number Other (Please specify) How long has your organisation existed?
ABOUT YOUR PROJECT: Please describe your project detailing where the project will take place, how it is accessible to Helena Partnerships tenants, who will benefit, which key resident priorities, aims /objectives the project fits into, how you will manage your project and the intended outcomes you hope to achieve: This is where you should describe the purpose of the project/activity you are undertaking, how it will be run and what you want to achieve from running it. You need to provide as much information as possible here including which of the 4 key resident priorities it fulfils, where it will take place and which Helena tenants it will benefit. We would like you to tell us how the project will be managed and what you hope to achieve from delivering it. Specifically you may want to tell us what problem you are looking to solve by undertaking this project
About your project – continued:
When is your project taking place as we may like to take the opportunity to come and see how the money was spent? If possible, we would like to attend some events delivered by groups using the community fund
How many people will benefit from this project and how many of these will be Helena Partnerships tenants/dependants etc. (You will need to demonstrate this as we need to see a majority of Helena tenants benefiting from the project) Please ensure that you detail how many people will benefit from the project. You will have to demonstrate how you can show that a majority of Helena tenants/households will benefit, how many non Helena tenants will benefit and how you can evidence this
Please give details of any consultation you have undertaken with residents and local groups about your project and provide copies of any flyers/leaflets. Please detail how you have given equality of opportunity for everyone on the estate to participate in your project, for example those who do not speak English, those who do not read etc. Can you also detail how you will advertise this Helena Homes grant: Why was it decided to run this specific project? You will need to show us how you have undertaken consultation to run the activity, what came out of this consultation, how have you given all residents equal opportunity to take part/participate and how you will advertise that Helena have given funding, if you are successful.
PROJECT COST: What is the estimated cost of your project?
£
What is the amount you are requesting from Helena’s Community Fund
£
(Note that Helena’s Community Fund does not necessarily have to meet the full cost of your project)
Please provide an itemised breakdown of the costs.
£
(Provide quotes)
£ £ £ £ £ £ Ensure you have provided full and itemised costs for your project. It is not sufficient to give an overall cost. Also ensure you have obtained quotes for the items.
Where will the remaining costs be funded from? You need to detail where you will obtain any outstanding money for the activity/project from
Has this funding been secured?
YES / NO (please delete as appropriate)
Acknowledge whether additional funding has be secured or not
Details of monetary and in kind match funding You need to tell us if you have any match funding, where it is from and how much, or in kind monetary contributions which can include volunteer time etc.
Have you applied for a Helena Partnerships Community Fund grant previously? If yes, please tell us the date you applied and if you were successful or not. Please let us know if you have applied to the fund previously and if you were successful. We will check our own records to ensure you have provided receipts and follow up questionnaire as failure to have done this will prohibit your application from being considered.
If your project is working with children, young people or vulnerable adults, do your volunteers have Criminal Records Bureau (CRB) clearance? Please let us know if the volunteers carrying out the project/activity have the relevant CRB clearance
DECLARATION:
I confirm that I am authorised to sign this application on behalf of my voluntary/ community group.
The information provided is, to the best of my knowledge, true and accurate.
If my application is successful, the grant awarded will only be used for the purposes stated in the application form
I agree to forward receipts to Helena to show the money was spent on the items outlined in the application form.
I agree to complete the feedback questionnaire following the project. I understand that failure to do so will stop any future application.
Name
Applicants name in full
Position
The position the applicant has within the group
Signed
Signed by the applicant
Date
Date the application was completed by the applicant
For official use only: Date stamp when form received
NB. Your application will not be considered if you fail to complete any of the sections, provide incorrect or false information or do not include all of the relevant documentation. You must ensure that on successful application to the fund, receipts are returned and the feedback questionnaire is completed. Failure to do this will result in you being unable to apply to future funds. You must include all the additional information required with your application? Your application will not be considered without them. Ensure you have included all relevant additional documentation, whether you have applied and provided the details previously or not. All documents must be provided for each application you submit.
Constitution Bank Statement (within the last 3 months) Child Protection Policy (If applicable) Public Liability Insurance Copy of Quotes (3 quotes) Flyers/Leaflets
Please return your completed application form to the below, ensuring you have attached the relevant documentation, to the: Community Engagement Officer Helena West Neighbourhood Office 70/72 Thatto Heath Road, Thatto Heath St Helens, WA 10 3QS
PROJECT TITLE: Please give a title to the project or activity you are carrying out (This is not the name of your group)
Please tick which resident priority you are applying under 1. Clean & Green □
2. Welfare Reform
□
3. Health & Wellbeing
□
4. Anti-Social Behaviour, Crime and Safety
□
APPLICANT DETAILS: Name of Organisation:
State the name of your group
Name of Contact Person:
State the name of the person responsible for this funding application
Address of Contact:
State the address to where all correspondence should be sent
Postcode:
Provided a full postcode
Telephone:
Provide the phone number the applicant can be contacted on
Mobile:
Provide the mobile phone number the applicant can be contacted on
E-mail:
Provide an email address where the applicant can be contacted on
YOUR ORGANISATION: Please tick the box which indicates the status of your organisation Please tick one Community Group Voluntary Group Registered Charity Number Other (Please specify) How long has your organisation existed?
ABOUT YOUR PROJECT: Please describe your project detailing where the project will take place, how it is accessible to Helena Partnerships tenants, who will benefit, which key resident priorities, aims /objectives the project fits into, how you will manage your project and the intended outcomes you hope to achieve: This is where you should describe the purpose of the project/activity you are undertaking, how it will be run and what you want to achieve from running it. You need to provide as much information as possible here including which of the 4 key resident priorities it fulfils, where it will take place and which Helena tenants it will benefit. We would like you to tell us how the project will be managed and what you hope to achieve from delivering it. Specifically you may want to tell us what problem you are looking to solve by undertaking this project
About your project – continued:
When is your project taking place as we may like to take the opportunity to come and see how the money was spent? If possible, we would like to attend some events delivered by groups using the community fund
How many people will benefit from this project and how many of these will be Helena Partnerships tenants/dependants etc. (You will need to demonstrate this as we need to see a majority of Helena tenants benefiting from the project) Please ensure that you detail how many people will benefit from the project. You will have to demonstrate how you can show that a majority of Helena tenants/households will benefit, how many non Helena tenants will benefit and how you can evidence this
Please give details of any consultation you have undertaken with residents and local groups about your project and provide copies of any flyers/leaflets. Please detail how you have given equality of opportunity for everyone on the estate to participate in your project, for example those who do not speak English, those who do not read etc. Can you also detail how you will advertise this Helena Homes grant: Why was it decided to run this specific project? You will need to show us how you have undertaken consultation to run the activity, what came out of this consultation, how have you given all residents equal opportunity to take part/participate and how you will advertise that Helena have given funding, if you are successful.
PROJECT COST: What is the estimated cost of your project?
£
What is the amount you are requesting from Helena’s Community Fund
£
(Note that Helena’s Community Fund does not necessarily have to meet the full cost of your project)
Please provide an itemised breakdown of the costs.
£
(Provide quotes)
£ £ £ £ £ £ Ensure you have provided full and itemised costs for your project. It is not sufficient to give an overall cost. Also ensure you have obtained quotes for the items.
Where will the remaining costs be funded from? You need to detail where you will obtain any outstanding money for the activity/project from
Has this funding been secured?
YES / NO (please delete as appropriate)
Acknowledge whether additional funding has be secured or not
Details of monetary and in kind match funding You need to tell us if you have any match funding, where it is from and how much, or in kind monetary contributions which can include volunteer time etc.
Have you applied for a Helena Partnerships Community Fund grant previously? If yes, please tell us the date you applied and if you were successful or not. Please let us know if you have applied to the fund previously and if you were successful. We will check our own records to ensure you have provided receipts and follow up questionnaire as failure to have done this will prohibit your application from being considered.
If your project is working with children, young people or vulnerable adults, do your volunteers have Criminal Records Bureau (CRB) clearance? Please let us know if the volunteers carrying out the project/activity have the relevant CRB clearance
DECLARATION:
I confirm that I am authorised to sign this application on behalf of my voluntary/ community group.
The information provided is, to the best of my knowledge, true and accurate.
If my application is successful, the grant awarded will only be used for the purposes stated in the application form
I agree to forward receipts to Helena to show the money was spent on the items outlined in the application form.
I agree to complete the feedback questionnaire following the project. I understand that failure to do so will stop any future application.
Name
Applicants name in full
Position
The position the applicant has within the group
Signed
Signed by the applicant
Date
Date the application was completed by the applicant
For official use only: Date stamp when form received
NB. Your application will not be considered if you fail to complete any of the sections, provide incorrect or false information or do not include all of the relevant documentation. You must ensure that on successful application to the fund, receipts are returned and the feedback questionnaire is completed. Failure to do this will result in you being unable to apply to future funds. You must include all the additional information required with your application? Your application will not be considered without them. Ensure you have included all relevant additional documentation, whether you have applied and provided the details previously or not. All documents must be provided for each application you submit.
Constitution Bank Statement (within the last 3 months) Child Protection Policy (If applicable) Public Liability Insurance Copy of Quotes (3 quotes) Flyers/Leaflets
Please return your completed application form to the below, ensuring you have attached the relevant documentation, to the: Community Engagement Officer Helena West Neighbourhood Office 70/72 Thatto Heath Road, Thatto Heath St Helens, WA 10 3QS
