tees valley small grants fund valley small grants fund ‐ application checklist it is important...
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About this form If you have downloaded this form from our website or received it by email you can type directly onto it and save your answers. You should save the form to your own computer first and you must have the latest version of Adobe Reader installed. Download it for free here. http://get .adobe.com/uk/reader/ You must not change any of the questions or alter any part of the form. If you do, we will not accept your application. If you are using a paper form please write clearly in black ink or type. Do not use correction fluid, as your application will be returned.
Tees Valley Small Grants Fund—Group Application Form
Tees Valley Small Grants Fund, is for voluntary and community groups based
within the Tees Valley. You can only apply for a maximum of £1000 in any
twelve month period from the Foundation*.
*This does not include the Goshen Fund.
There are help notes next to each question that explain how to answer
it.
For some questions you have a maximum number of characters that
you can use in your response, to give you an idea of the amount of
detail we need. You may well be able to answer these questions in
fewer characters than the maximum.
We update our funds and programmes from time to time, so if you have
had this form for more than three months, contact us or visit our
website to check that you have the most‐up‐to‐date version. We
published this version in April 2013.
If you have any questions please contact the office:
Calling us on 01642 260860
Email: info@teesvalleyfoundation.org
Sending us an email to info@teesvalleyfoundation.org
Follow the Foundation on Facebook and Twitter!
Teesvalleycf teesvalleyfoundation
Tees Valley Small Grants Fund ‐ Application checklist
It is important that you work through this checklist before you start completing this application form. This checklist has been designed to help you decide if this fund is right for your project or organisation, before you go to the time and expense of submitting an application. The checklist also helps us as it reduces the number of ineligible applications we need to process, which means we can keep our costs down and give more money out in grants.
Part one ‐ You must be able to answer YES to one of the options in Part one to apply
Is your group a: Voluntary or community organisation?
Registered charity or company limited by guarantee?
Parish or town council*
School**
Community Interest Company with 3 or more directors
*If a parish or town council this must be led by the community and not members of the council. **If you are a school you may only apply if your project takes place outside of normal school hours and does not form part of the National Curriculum.
If you answered no to all of the above then your organisation is not eligible to apply to our funds. Tees Valley Foundation cannot fund organisations who make a profit, councils or individuals.
Part two ‐ You must be able to answer YES to all of Part two to apply
Does your group: YES NO
Have its own bank account, which requires two unrelated people to authorise cheques and make withdrawals (including debit card or internet purchases and cash withdrawals)? This must be in the name of the organisation applying, unless you are a school.
Have a least three members on its governing body or board of directors
Operating and benefiting the communities of Stockton‐on‐Tees, Middlesbrough, Redcar & Cleveland and Hartlepool.
About your project: YES NO
Is your application for £1000 or under
NB Please be aware we cannot fund organisations promoting religious and political activity or fund activities which have already taken place.
If you answered no to any of question in ‘part two’ please contact our office on 01642 260860 to discuss as we may not be able to fund your project.
Read these help notes Question 1 Give the full name as it appears on your governing document. Tell us your organisations main address, including postcode. Question2. This must be the person that submits the application. They should be someone from your organisation who can talk about your project and who we can contact during office hours. They must be over eighteen year old. For schools, someone who is directly employed by the school must submit the application (for example, a teacher or administrator). For voluntary and community organsations you must give your home address. For schools, parish or town councils give your business address (or put ‘same as question 1’ if appropriate). Tick one box only These might be textphone, sign language, large print, screen reader, audiotape, Braille or a community language. Please give the town, district, county or region your group operates in.
Section 1: About your Group/Organisation
1. Organisation and contact details
Name of Group/Organisation: Address of Group (please include postcode): 2. Contact Details Title: Forenames (in full): Surname: Position in organisation: Address (if different from above): Landline number: Second contact number: Email address: Which address should we use to notify you of our decision? The main organisations address Or The address of contact person Do you have any communication needs? Yes No If yes, what are you communication needs? You can write up to 200 characters with spaces (about 20 words) Which geographical area does your group carry out most of its activities?
Read these help notes Please tick one box only. Please provide your charity, company or DfE number if applicable. DfE stands for Department of Education. If your organisation has a membership we expect this to be open to all and that anyone can join, unless you can provide a good reason why not. We will usually consider proposing and seconding to be unacceptable and we expect there to be the right for appeal for anyone refused membership. We need to know how many people make up your board or committee and who makes decisions. Please tell us how many people are involved and how often they meet? Do you involve volunteers, if yes how many?
Section 2: Your Governance & Membership
3. Your Membership
Are there any restrictions on who can join your organisation? YES NO If yes please explain: Does your constitution (set of rules) show the power to raise funding? YES NO If ‘no’ why not?
4. Your Governance
How many people are on your organisation’s governing body? How often do they meet? Do you have volunteers? YES NO If ‘yes’ how many? If ‘no’ why not? Do you employ any staff? YES NO If ‘yes’ how many? Full Time Part Time
A) Charity Number (if applicable) B) Company Number (if applicable) C) DfE Number (if applicable)
2. Please provide relevant registration numbers
Voluntary or community group School Parish or town council Community interest company Registered company Registered charity Other (please provide details):
1. What type of group/organisation are you? (please tick as appropriate)
1. Organisation details
Read these help notes When did the group first start meeting or running activities or projects. Please give a brief statement of your groups activities. Safeguarding is imperative to any group or organisation working with children or vulnerable adults, the foundation will only award a grant to groups that can evidence not only their understanding but implementation of safeguarding policies to ensure every child or vulnerable adult is kept safe. Please make sure you tell us about the safeguarding in your organisation. Our assessors may ask questions around these policies so please ensure whoever is completing the form is aware of this.
When was your organisation established? What is the charitable aim of your organisation/group? What are you usual activities?
Section 3: About your Organisation
Do you work with children &/or vulnerable adults? YES No If no go to section 4, if yes do you have the following: YES NO
Child Protection Policy:
Vulnerable Adults Policy:
Responsible Safeguarding Representative:
Registration with Local Safeguarding Board:
Are you aware of definitions of abuse?
Are you staff & volunteers CRB checked?
Read these help notes Your account MUST be in the same name of the organisation who is making the application and will carry out the project. We require at least two people to sign each cheque or authorise a withdrawal (including debit card or internet purchases and cash withdrawals). If any signatories are related or live at the same address we will need written confirmation from your bank or building society that these people cannot authorise the same payments. If you are a school, a local authority bank account is acceptable. Question 1 If your organisation has been running for less than 15 months, please provide a 12 ‐ month financial projection for the year when you will spend the grant. Please include the amount you are requesting from Tees Valley Foundation in your projection. This should include all the income your organisation has received and all items of expenditure for your last financial year. For schools it should include your whole school budget. Surplus ‐ is the amount of money you have left at the end of the year. Deficit ‐ did you not have enough money from your income to cover your expenditure? Reserves ‐ how much money does your group or organisation have in reserve? This might include restricted money that you have received from another grant/fund, please provide details.
Does your bank or building society account meet our requirements? (Read help notes) YES NO If yes, please give details of the bank of building society account into which we would pay the grant: Name of bank of building society you hold an account with: Your account name (the organisation name on your statements): Sort Code: Account Number: Building society roll number (if appropriate): How many signatories do you need to authorise a cheque on this bank account?
YOU WILL NEED TO SUPPLY EVIDENCE OF THE ACCOUNT AS ABOVE IN THE FORM OF A BANK STATEMENT, CHEQUE STUB OR OFFICIAL LETTER FROM YOUR BANK OR BUILDING SOCIETY SHOWING THE DETAILS GIVEN ABOVE. PLEASE ENSURE YOU ENCLOSE THIS
WITH YOUR APPLICATION & CONSTITUTION.
1. Provide a summary from your most recent accounts or financial statements
Are the figures you are providing below from:
Your latest accounts or financial records of your organisation? or
Projected because your organisation has been running less than 15 months?
Account year ending: dd/mm/yyy Total income for the year (A) £ Total expenditure for the year (B) £ Surplus or deficit at the end of the year (A—B) £ Total savings or reserves at the year end £ Is any of your reserve restricted for a particular purpose? Yes No If yes, how much?
Section 4: Accounts
PLEASE NOTE THAT WE MAY ASK TO SEE YOUR ORGANISATIONS LATEST SET OF ACCOUNTS FOR MONITORING PURPOSES.
Read these help notes This date must be at least 4 weeks after the date the application is received. Use this section to explain exactly what the money would be used for. Please include details of the activity and how it would benefit the local community. We need to be able to assess the value of your project, please tell us how many people will benefit and in what way. If you get a grant we will ask you to give some feedback on what difference your project/activity has made to your group or community. Some of the things you might do include asking your participants what they thought and recording this, taking photographs or a more official evaluation. Will you be able to continue with you project/activity once this grant is used?
1. Your Project
Project/ activity title: When will the project/activity start? Finish? Please describe your project or activity. What do you want to do with this grant? Why does your local community need this project/activity? How many people do you expect to benefit from your project/activity and in what ways? (max 200 words) How will you judge the success of your project? (max 200 words) If this is an ongoing project/activity, how will you pay for it in the future? (max 50 words)
Section 5A: Project Details
Read these help notes Maximum grant is £1,000. You need to supply details of all of the items you wish to buy in the table in this section.
Please tell us if you are applying to any other funder for any part of the project described in this application. (please indicate money already secured with an S)
How much are you applying for? How much is the project/activity going to cost? Please provide a breakdown of the project budget:
If you are not applying to this fund for the total cost of the project how do you intend to finance the rest? Does your group actively fundraise? If yes, how? If no, would you like to receive further info on help with fundraising? YES NO Please show us in table below any other funds that you have applied to for this project:
Is there anything additional that you would like us to know in relation to your application? (Max 200 words)
Item or activity Cost:
Name of Fund Amount Applied For:
Section 5B: Project Details
To help us monitor our grant programmes, please answer the following questions:
Information used in this form will be used for monitoring purposes only and will not affect your application. Details may also be recorded on a database, which will be used to gather general information that may be made public with‐out permission. If you would like to discuss this further please contact a member of the Grants team at Tees Valley Community Foundation.
1. Age Group In the box below please enter a single option from the list below. This should represent the primary age group that will benefit from this grant
Other age groups affected, (please tick all that apply)
Early Years ( 0‐4) Young People (13‐18) Adults (26‐65)
Children (5‐12) Young Adults (19‐25) Seniors (65+)
2. Beneficiaries In the box below please enter a single option from the list below. This should represent the primary beneficiary group that will benefit from this grant
Other beneficiary groups who will benefit, (please tick all that apply)
Children & People with general Families
young people health issues
Adults People with learning Carers
difficulties
Older People People with physical Local residents
Disabilities
NEET( Not in education, People with mental People in Rural
Training or Employment) health difficulties areas
Long term People with weight/ People in Urban
Unemployed Obesity issues area
Disadvantaged/ low Alcohol/ drug Migrant Workers
Income addiction
Lone Parents BME groups (Black & Men Minority Ethnic)
Homeless People Ex offenders and Women
prisoners
Refugees/Asylum Lesbian, Gay, Bi‐sexual
Seekers & transgender groups
Other (Please State:
Application Monitoring Form
3. Ethnic Origin In the box below please enter a single option from the list below. This should represent the primary Ethnicity group that will benefit from this grant
Other ethnic groups who will benefit, (please tick all that apply)
White Mixed Asian and Asian British
British Black Caribbean & white Indian
Irish Black African & white Pakistani
Eastern European Asian & white Bangladeshi
Gypsies & Other Dual Ethnicity Other Asian
Travellers
Other white
Black or Black Chinese or other group
British
Caribbean Chinese
African Any other
Other Black
4. Issues In the box below please enter a single option from the list below. This should represent the primary issues that will be addressed from this grant
Other issues addressed, (please tick all that apply)
Arts and Culture Health and Wellbeing Social Inclusion
Community Support Housing Social Services and and Development activities
Counselling/Advice/ IT / Technology Sport and Recreation
Mentoring
Crime Poverty & Disadvantage Support family life
Disability & access Racial and Transport issues
Issues cultural integration
Education and Religion Volunteering
Training
Employment and Rural Issues Other (Please specify):
Environment/recycling/ Social Enterprise Renewable energy
Application Monitoring Form
TERMS AND CONDITIONS
We agree to abide by the following terms and conditions:
We will only spend the grant for the purposes as agreed in our offer letter unless we have received written
confirmation from Tees Valley Community Foundation (hereinafter referred to as the Foundation) that we
can make a variation to spend.
If the information in the application changes in any way we will inform the Foundation.
We agree to return any unexpended balance of the grant not used for the agreed purposes to the
Foundation.
We accept that the Foundation will, under no circumstances, be liable for any damage, injury or loss of any
kind whatsoever to any property or persons occurring as a result of activities undertaken with this grant.
We will ensure that all necessary permits and licences have been obtained for any event or project funded by
the grant and that the event or project complies with all relevant regulations.
We acknowledge we cannot sell or dispose of any equipment or other assets funded or part funded by the
Foundation without first receiving written permission. If any equipment or assets are sold within their
working life without such undertaking, the Foundation can ask for a percentage of the original grant to be re‐
paid.
We realize we must keep all financial records and accounts including receipts for the items bought with the
grant for at least six years. These must be made available to the Foundation if requested.
We agree to acknowledge the support of the Foundation and the fund/donor that has made the grant
possible in publications, press releases and elsewhere as appropriate.
We agree to complete a grant monitoring report (which we will receive with our offer letter) and return by
the prescribed date together with copies of all project invoices and receipts. We understand that failure to
do so may prevent us from future funding from the Foundation.
We give permission for the Foundation to record the information in this form electronically and to contact
our organization by phone, mail or email with regards to this application.
From time to time Tees Valley Community Foundation may contact you with information about the Foundations activities or pass your details on to other potential funders that might be interested in your project/activity. If you do not wish to be contacted for these purposes please tick this box. Tees Valley Foundation would like to publicise as many successful projects as possible, if you are happy to be contacted for marketing or PR purposes, please tick this box.
Have you signed all sections of the application form? It is important that you don’t miss anything out as the application form is what our decisions are based upon. In some cases our assessors will need to contact you so please ensure your contact details are clear and that the named contact on the application is able to answer any queries we may have. You may email your application to : info@teesvalleyfoundation.org
If you are emailing you won’t be able to sign your application so therefore PRINT THIS PAGE and send to us WITH EVIDENCE OF YOUR NOMINATED BANK ACCOUNT & CONSTITUTION OR SET OF RULES.
If you are completing this application by hand or would prefer to send in the post then please print the entire document and sign along with evidence of your nominated bank account and a copy of your constitution or set of rules.
DECLARATION I am authorised to submit this application on behalf of the group and certify that the information enclosed is correct. If a grant is awarded, I am authorised to accept the terms and conditions (stated on the previous page). My signature confirms that I have read the terms and conditions and I agree to manage any grant in accordance with them. Name: (please print) Position: Signature: Date: INDEPENDENT REFEREE: Full Name: Organisation: Address: Contact Number: Email: Signature: Date:
Please return you completed application by email to info@teesvalleyfoundation.org or by posting to: Tees Valley Community Foundation
Wallace House, Falcon Court, Preston Farm, Stockton on Tees
TS18 3TX
PLEASE REMEMBER TO CHECK THAT THE ENVELOPE CONTAINING YOUR APPLICATION HAS THE CORRECT POSTAGE APPLIED TO IT.
Registered Charity No. 111222 Registered Company No. 5478088
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