For office use only:

Group application form Please read our grant guidelines before completing this form or the electronic version available from www.bankscommunityfund.org.ukThe form should be returned to: james@bankscommunityfund.org.uk together with any other supporting documents required. Although we prefer email, you can return this form and supporting documents by post to The Banks Community Fund, PO Box 542 Durham DH1 9EH.Tel: 0191 378 6342 Charity Number: 1047625 Company Number: 3072153

Section 1 – Your organisation1.1 Contact Names and details. Please ensure the name of your organisation is the same as the name on your constitution/governing document. The contacts you provide should be the people who, if need be, can discuss the project in detail and who are authorised by the applying organisation to sign on its behalf.

Name of your organisation

Contact details Primary contact Secondary contact

Title (Mr, Mrs, Miss, Ms, other)

Contact name

Position (within organisation)

Address

Postcode

Daytime telephone number

Mobile telephone

E-mail address

Section 2 – Which fund are you applying to? 2.1 Please indicate which fund you are applying to (place X in one box only)

Fund Name X Distance in miles from project

Armistead Wind Farm Community Fund

Hazlehead Wind Farm Community Fund

Marr Wind Farm Community Fund

Penny Hill Wind Farm Community Fund

Heysham South Wind Farm Community Fund

Brenkley Lane Surface Coal Mine Community Fund

Rusha Surface Coal Mine Community Fund

Banks Community Fund

Other: please state in box below:

Date received DIGITS Ref

Section 3 – Project costs

3.1 Project costs. What is the total cost of the project/activity including VAT? Please provide a breakdown of the project budget.

Item or activity Cost (£)

Total costs of items listed above £

How much are you applying to us for £3.2 If you are not applying to us for the total cost of the project how do you intend to finance the rest of the project? Please tell us if you are applying to any other funder for any part of the project described in this application. Other Funders:

Funder Applied for/Awarded (£)

Total £

3.3 Is your organisation VAT registered? Yes

No

3.4 If yes, what is the recoverable VAT on the amount you are asking us for? £

Section 4 – What type of organisation are you? 4.1 Please fill in all the relevant boxes. You do not need to be a registered charity to apply, but you do need to have a constitution or a simple signed set of rules for your group

Yes No

Community or voluntary group with a written constitution

Company Limited by Guarantee - please provide your registration number

Registered charity – please provide your charity number

Local authority or Parish/Community Council

Unincorporated club or association

Community interest company

Is your group a branch of a larger organisation? If yes which?

Other (Please specify)

Environmental Body If yes what is your registration number?

4.2 What does your membership clause state?

4.3 What does your dissolution clause state?

4.4 Please confirm which of the following policies your organisation has: (place x in box)

Child Protection Policy Vulnerable Persons Policy

Environment Policy Procurement Policy

Section 5 – About your group In this section you should detail why your group was set up, what the aims and objectives of your group are and who are the main beneficiaries of the work your group carries out.

5.1 When was your group set up?

5.2 When did the group first start meeting or running activities or projects?

5.3 Briefly describe the purpose of your groupIn this section you should detail why your group was set up, what the aims and objectives of your group are and who are the main beneficiaries of the work your group carries out.

5.4 How do you promote your organisation in the local community?

5.5 How many people are involved in your group (please give numbers)

Management Committee Members (if appropriate)

Users of your project/group Volunteers (non-management)

Paid staff (full time) Paid staff (part time)

5.6 Does your group have its own bank account Yes No

5.7 How many signatures do you need to authorise a cheque on this account? Please state number

5.8 Please confirm which of the following documents your organisation has.

Audited accounts Independently reviewed accounts

Unaudited accounts (e.g., receipts and payments only)

Cash flow projections (for groups’ less than 12 months old)

5.9 If a grant is awarded, a cheque will be raised, please complete the relevant bank details:

A cheque should be made payable to: Account name:

Section 6 – Your Project6.1 Where is your project located? Please complete all sections. If your project is on land which has no postcode please state this and provide the postcode of the nearest building.

Name of Site (if applicable)Street Town/VillageCounty

Post Code

6.2 Please describe your project and what it is you want to achieve. This should include details about your project and the physical works which will be undertaken

6.3 Who owns the land on which the project is located? Note either the primary or second applicant must either be the landowner, leaseholder or have an appropriate management agreement for the site. Please provide land ownership and lease details and arrangements or permissions you have to use the site and undertake the project.

6.4 What are the proposed timescales for the project? Please do not put “ASAP” or “When funding in place” as your application will be returned. Please remember it may take up to three months for your application to be processed. Projects should be started within 6 months of decision and completed within 12 months of the start date. Estimated Start Date

Estimated Completion Date

6.5 How do the general public have access to your facility?

Please state opening and closing times for the general public or when the facility is available. – Not when it is used.

Monday Please detail your booking, lettings policies or arrangements for

access Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

6.6 Please provide details of any current user groups and organisations that use your facility.

6.7 Are there any times when the facility is unavailable or there are restrictions as to who can use the facility?

6.8 What charges are there to use the facility? If you make charges to use the facility please detail your charging policy and costs.

6.9 How and where will the facility be advertised, both on completion and once open? This could be through local papers or newsletters, websites, local libraries or notice boards outside your facility.

6.10 Is planning permission or any other form of consent required? If yes, you must have already obtained planning permission or approval and you must provide details. If yes, please provide details below

Yes

No

Section 7– Project Benefits 7.1 How have you identified the need for the project? We want to know that your project will address a genuine community need. For example, if there is an existing facility how have you identified what needs to be done? If it is a new facility how did you identify what your community needs and have you carried out any work to show the project will meet those needs?

7.2 What evidence do you have that local people support your project? Evidence could include petitions, outcomes of community consultations or appraisals, outcomes from open days, letters of support from new or existing users, fundraising initiatives or any other evidence that the community back your project.

7.3 How will the project benefit the local community? It is important that we know the difference your project will make to the local community and/or environment. Please detail how your project will improve your community and/or increase access to facilities for the community and not just current users.

7.4 How many people currently use the facility each month and how will the project encourage new users? How will your project broaden the appeal of your facility for new user groups or visitors?

Section 8 – About the environment 8.1 About the environment? Yes No

Does the project protect the environment?

(If yes please explain how by ticking the relevant box below) Yes No

Deliver biodiversity conservation for UK species

Reduce or prevent pollution on land

Reclaim land

Provide or maintain public amenities or parks

Restore or repair buildings for religious worship, or of architectural or historical interest

Other: please explain below

Section 9– 10% direct reimbursements9.1 10% direct reimbursements. If your application is successful, you will normally need to provide a 10% reimbursement (see guidelines). Please provide details of how this will be paid, including contact details of the person/organisation paying the 10% reimbursement.

Name

Organisation Address

Postcode

Contact number

If your organisation is providing the 10% reimbursement how did you raise the money?

Section 10 – Declaration 10.1 Declaration We are authorised to submit this application on behalf of the group and certify that the information enclosed is correct. By signing this application form, we agree to abide by the Terms and Conditions included in the Grant Guidelines and any additional special conditions detailed on any offer of a grant letter sent by The Banks Community Fund. We understand that we will be expected to monitor expenditure and provide The Banks Community Fund with receipts and a report on the progress of the project. We give permission for The Banks Community Fund to record the information in this form electronically. Name 1 (Person submitting the form)

Date:

Name 2 (Chairperson or senior representative of the management committee)

Date:

Section 11 – Councilor Support 11.1 Councillor support Please provide the name of a Councillor (County or District in England and County or Ward Councillor in Scotland) who knows your group and supports your project and has already confirmed he/she is prepared to provide a reference if required.

Councillor Name

County / District/ Ward

Contact Address

Postcode

Telephone (day) Telephone (evening)

Email

Section 12 – Additional information 12.1 Where did you hear about us?

Website Local CVS

Funding surgery Word of mouth

Local media Other (please specify)

Section 13 – Checklist 13.1 It is important that you send all the necessary information with this form. Please use the tick boxes to confirm enclosure.

A set of your accounts signed by your treasurer. If your group is less than 1-year old you should send a one-year budget (showing projected income and expenditure) plus a bank statement. Both must be signed by your treasurer.If your project supports biodiversity conversation for UK species habitats, “Biodiversity and Habitat Conservation Form” to be completed. (to be supplied)

Photographs

Maps

Plans

Planning permission

You may be requested to send other documents to support your application, these would be requested, please do not send any other information at this stage.

Return AddressPlease return completed forms to:

James EagleshamFund ManagerThe Banks Community FundPO Box 542DurhamDH1 9EHTel: 0191 378 6342E-mail: james@bankscommunityfund.org.uk

Charity Number: 1047625 Company Number: 3072153