..4 London Borough_ of Hounslow

Closing Date: 4 January 2011Community Investment & CohesiCommunity Services R lEe iEI[VI if;:, i!~..

- ~ JAN 2011

COMMUNITY INVESTMENT FUND 2010/2011APPLICATION FORM

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Postcode:, W 3 \NY

Telephone Number: OlO~ . Fax: Email: p(~Hn!\L9.tl~bl::-°F«'rl~lt{.C v11c; ~L &-~y 2

Name of contact person: 1)e<3ozAvt 6AfZN c'lT

Postcode -r~~ /N'I-Telephone Number: (:) OLO <? Fax:

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Amount of grant applied for £' ~ 000

Please specify one criteria category under which application submitted. (Refer to enclosedlist of qualifying criteria).

1. What are the main services of your organisation?

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pe-cp\ So'thej C0n -thm b.A;\d ccnf7'c/ &'lee to 3~~into~e CO{VyY)l.1()'~ t-0coethc:r cO t-Qke pore jf) CAcho,heS.~e.0 l.-UQ..Ald o·thet"vu·,Se 6e- uf\C\6Ie to -I=c.ke::- (JOlt ;n,

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2. Please give a brief description of the work or project for which you are requestingfunding.

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SOY\ e. lA.)/Iv, P"'~~;Ca;.1 f l e-G(";A~ or SOCred di fflcVllh'es.

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<And FCf ~e;( C0;\dre/) t-o (//OJ il\ Ct Sc;fe.. ef'uirOlfV'enf.. .

'1he. Mc.j01'~ Of OAr JCMf'Jpeeplt:' ad-fend SChc>c>\ or

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Lue.- rrcu,'d e. ~L SuppO/c ~ e~ 1\<' e cl t-o clo f'h )'s.

4. Please give a breakdown of the main tasks involved in the setting up/running of yourproject:

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5. How do you intend to continue to fund the project after the Council's grantends?

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TV'\ spcnscyed euent~ end ~~res.

If YES, please give charity registration number:If NO, please give status of your organisation

Are you affiliated to any other national, regional or localvoluntary organisation?

If YES, please say which:P~ob lA '-< / ~10J{\SJ~ yO.A h, S -era ,ce

Does your organisation have a Management or Executive committee§NO

yes

ChairpersonVice ChairpersonTreasurerSecretary

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b ~e ccn ~Q\d \:?o~

Please list skills and experience necessary to carry out these posts.PDS 1\J'm-S .A\l St-~ff hc>\.J-e.. CCM(Jlet ed Or tA1cf{'i~ki~ re le,ucnt

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(e~V1\ved t-o ~Cl.l.<e{701t- I () COIhf1U;':5 {YrU'/f'I\f\-S f<YcleuelCfeMeniHow many volunteers are regularly involved in the work:of your organisation?

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'De6\o'i e. barl'e.CcHow many paid staff does your organisation employ?

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1(\ ~ea\~ f. Socla\ (Ore.. end dc\(\~ ~e. ll\rvoduCh'Q1

~o '1OJ.t'h WO/L( CC\prSe... \J o\l.nt-e-ers, w"'-o Ore

C'\o\~ 'VLAI<.e- Of- Ed;n l:>LAr8~ I LA.)Ovl.( ~ >cpeJ1fflce or o..-S.

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2. What age groups are the beneficiaries and how will you involve them in thedevelopment of the project?

II - '2 ~ ~ .ecrS

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Do you undertake your activities anywhere else other than the above ~~address? YE~

If YES, please indicate where?

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Have you received any previous grant from the London Borough ~of Hounslow? ~/NO

If YES, please state amount, year of most recent grant and thedepartment received from:CQrpcra~e (Z-e-uenve- CICt't- t S/000

Are you currently receiving a grant from another London Borough ~I

of Hounslow department? ~NO

If YES, please give details:Ai(V\\I1J \A\5~ j{O"f fQ t,Z-:;, DOO encLn5 3lS, riorC/n 201) per-

S Sepo/Ote. (?Icjec*=.s (SOS/AoS1

3G~lArd~ CrCCu0S)3. Are you currently receiving a grant from any other organisation? YES,@

If YES, please state name of organisation, amount and purpose ofgrant:

YES@

If YES, please state name of organisation, amount and purpose ofgrant applied for:

YEs(@)

YEs(§>

@NOYES@

£

Estimated Expenditure £ Estimated Income £

1 Staffing costs -~ 7/1 2o)1t1.1~' 1 Fees/subscriptions/other Lt4\~iXs tCt.fF- chargesGross salariesEmployers N.!.Superannuation

Subtotal t20, 4-,::};i4

2 Trusts/Companies2 Premises costs

a) Rentb) National non-domestic ratec) Repairs and redecorationd) Furniture and fittings "-.I/Ae) Other (please specify)

Subtotal3 Donations/Sponsorship (give

details) C3 Running costs S1ig,w /;1eCft6ec.r l,,{jke S:~~cYed) ?:>aO.DO

a) Telephone ~A .- ,. LovY dd WCdk 266DCJI VCJ\CI.<.E'f\ 'I e 1"'6 t-O'Ib) Printing and stationery] 434.00 (JA ,=cr-e.s US3..00c) Postage 4 Income from other sources,

not included above (givedetails)

d) Insurance - ~I( \ (\ St.-.rOl ce 30Q.(X) (l.A.e) Gas, Electricity, Heatingf) Other expenses

e.g. creche, transport,training

Subtotal r?>bl.oo

4 Cost of other activities(Please show total estimated 5 Cash balancescost of other activities with abreakdown of costs for eachActivity

Subtotal

5 Any other expenses (Please 6 Total grant requested fromgive full details) London Borough of Hounslow {Sp:r;.oo

(A) Total Estimated 1..\ ':1~g.14 (B) Total Estimated Income 'lei b::f· rxExpenditurePlease note: (A) should equal

B) <0cl.L (h~ ~ ""'''' fL~~ ~!t= ~

1. Please indicate the extent of involvement of the community in the activities ofyour organisation as follows (give approximate number where possible)

Women Minority People with Older Young *OtherEthnic disabilities people people appfCxj-

User rou 0 ~ 140 5 t~o Mete.MembershiManagement Z- ScommitteeEm 10 ed staff I

*e.g. gay men and lesbians, ex-offenders, or any other sections of the communitythat your organisation targets.

Post titleLe-odeJyeu \\A w C¥t< erS

- Y()...A~ v00!k hOJ(s ucr.:jd ep60d; "j (Y) woJl<ef

VlCf'l~f~'f'Qvl -:; - 2S; h.ev, S

If part-time, please indicate the number of hours worked per week

PT/FTPTp,

Current salary NI + other costs-k I C; (7-'21~r

£ C) pe.r hr

Fundingauthority

Does your organisations have a written statement andlor a code ~}of practice regarding equal opportunities/diversity? ~NO

If YES, please attachwe- Fo\\Cv0 MG.A\SlO-J YCcA~ Sc:r0 iC-e3, po\iC~

This form should be signed by the chairperson, secretary or treasurer ofyour organisation

Signature ~001 Please also print name '1), 6Af2t--JEi r

Please return this form to:Corporate Community Investment & Cohesion UnitCommunity ServicesLondon Borough of HounslowCivic Centre, Lampton RoadMiddlesex, TW3 4DN