Community and Dementia Funding

Transcription

1 Community and Dementia Funding 2017 to 2020 Development Funding Option 3 Sample application form Please note that you will be asked to make your application via our online system, which will open on 17 January The online form will be very similar to this sample application form in terms of the questions asked and information requested. DO NOT SEND US THIS APPLICATION FORM Page 1 of 16

2 Completing the application Please read the Guidance Notes for Option 3 before completing this form. If you have any questions please contact Graham Hart, Insight and Evaluation Officer at graham.hart@lifechangestrust.org.uk or on and a member of the People Affected by Dementia Programme team will get in touch with you. Applications must be received no later than 5pm on Thursday 30 March The online application will be open via our website from 17 January It is your responsibility to make sure that your application is submitted to the Life Changes Trust by the deadline. The Trust cannot accept responsibility for applications that do not reach us, for whatever reason. Page 2 of 16

3 Your Contact Details Please provide your contact details below Title: Full name: Job title: Address: Telephone: Website address (if applicable) Page 3 of 16

4 Your development work Please indicate the status of your development work: New initiative Established (please state when initiative was established)... Is your development work in relation to a geographical community? a community of interest? Page 4 of 16

5 Your Organisation Please provide details for your organisation below. Name of the group/community/ organisation What is your role in the group/community/ organisation Legal status Please provide registration details for your organisation (e.g. OSCR or Companies House) Please state the year that your organisation was established if less than 5 years ago Public body Registered Charity Company Limited by Guarantee Private Limited Company Community Interest Company Other (please state) Page 5 of 16

6 Consortium Application If you are completing this application on behalf of a group of organisations, please list the names of all the organisations involved and their role within the development work. Please provide a signed statement of support from each partner. (Add more lines where necessary). Name of Organisation Role within the development work Page 6 of 16

7 Development Proposal Please refer to the Guidance Notes for more information on the Trust s expectations for the Community and Dementia approach. Please provide a summary of your overall funding proposal (maximum of 1,000 words). Summarise the role and responsibilities of the development post that you are requesting funding for (if applicable) the development work that will be undertaken how this will be done and who it will involve how people affected by dementia will be involved in the development of your Dementia Friendly Community how you will consider equality issues and reach a diversity of people with dementia and carers in your community, including those who might be more difficult to reach Page 7 of 16

8 Delivery of your development work Please refer to the Guidance Notes for more information on the Trust s requirements for Community and Dementia funding Summary Please provide a summary of what you propose to do with the funding (maximum of 1,500 words). Summarise: what you will do how you will deliver it how you will involve people affected by dementia how you will consider equality issues and reach a diversity of people with dementia and carers in your community, including those who might be more difficult to reach Outcomes Please specifically address how you will start working towards the following outcomes for people living with dementia and/or unpaid carers (maximum of 1,000 words): I have a significant say in how my dementia friendly community is run I know I have a community of support around me I am included I am safe, listened to, valued and respected I am able to do the things that matter to me Page 8 of 16

9 Project plan Please provide us with a project plan that covers the following: Your overall aims and objectives Timelines and milestones Activities you will carry out to start meeting the outcomes listed on p.8 for people living with dementia and unpaid carers (plus any additional outcomes) Activities you will carry out in order to build a stronger organisation and work in partnership with others How you will build the capacity of your organisation and others to meet the needs of people with dementia and carers by increasing skills and experience, as well as increasing opportunities for further growth and development How you will develop strong and effective links with existing Dementia Friendly Communities Page 9 of 16

10 Learning and Sustainability 1. How will you make sure that you are developing on an ongoing basis the skills, capacity and commitment of your organisation with a view to building a dementia friendly community? 2. How will you make sure that the benefits of your project can be continued beyond the one year of Trust funding? Page 10 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

11 Evaluation The Life Changes Trust believes that appropriately robust evaluation of the initiatives it funds is crucial for turning knowledge and learning into action. You may include in your breakdown of costs an estimated amount for evaluation of your development work. The Trust will discuss evaluation plans and evaluation support with every successful applicant. Please outline how you plan to evaluate your development work (500 words maximum). Note that you will be required to submit evaluation evidence to the Trust on a six-monthly basis and this evidence will be collated with evidence from all the other Communities so a national progress report can be written. Page 11 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

12 Staffing profile Please provide details of any staff posts you would like the Trust to fund in relation to the delivery of the development work. Please provide information for any member of staff whose costs are included in your proposal (these can be full costs or part costs, e.g. if you would like us to make a contribution to a salary). Insert additional lines if there are more posts. A job description is required for the post-holder who will be the day to day lead member of staff for this proposal, even if you do not require Trust funding for this post. If you are requesting funding to employ a new member of staff please attach a draft job description for this post with your application. Job Title: Is this a new post? Yes No Please provide details of any other staff involved in the delivery of the development work. Page 12 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

13 Funding Please refer to Section 6 of the Guidance Notes before completing this section. Development funding of up to 35,000 can be awarded for one year for a co-ordinator, development post or other developmental work. There must be an in-kind contribution(s) of at least 10% of the total funding request to the Trust. Development costs can include, among other things, awareness raising, planning events, partnership working and liaising with people affected by dementia. Please indicate how much funding you will need for the year. You can apply for any amount of funding up to 35,000 for the year. LCT Funding Request In-kind contribution(s) Total funding request What is the source of your in-kind contribution(s)? Please provide written confirmation of these contributions from the people/organisations making them, including confirmation that they will be available for use from the agreed start date. Please use the Excel template to complete a draft budget for your proposal. Your proposal will not be considered without this. Please complete the relevant budget lines you do not need to use them all. If you require a budget heading which is not in this table, please add it. A column is provided for any match funding, if applicable. The Total request column should show how much funding you require from the Trust. Page 13 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

14 If VAT is applicable to any of your costs, please confirm in the notes section which specific costs this relates to. Trust funding can only be used to support activities related to the delivery of your development work. Please explain how you will manage and monitor your project budget. Policies Does the project have current policies on the following? Please send a copy of all that apply: Adult Support & Protection Yes No Protection of Vulnerable Groups Yes No Health and Safety at Work Yes No Reserves Yes No Page 14 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

15 Accounts Please provide figures from your latest approved accounts. Please send us a copy of your most recent accounts. Accounting year ending Total income for the year Total expenditure for the year Surplus or deficit at year-end Date DD/MM/YY Total savings or reserves at yearend If there is anything you want to explain about the figures entered above, please do so in the box below: Commitment to collective learning The Trust expects the initiatives it funds to be committed to building relationships with each other in order to learn from each other. This will require regular interaction between the initiatives and a genuine willingness to share learning so that a Community of Learning and Practice is firmly established. You will be required to attend quarterly gatherings of Trust-funded projects in Perth. Please indicate whether or not you are committed to this collective learning: Yes No Page 15 of 16 Community and Dementia Open Call Sample Application Form: People Affected by

16 Checklist In addition to your application, please ensure you send us the following documents: Copy of last audited/independently examined annual accounts Job description(s) Supporting statements from partner(s) Completed budget sheet with in-kind contribution(s) Relevant policies Page 16 of 16 Community and Dementia Open Call Sample Application Form: People Affected by