The Brechfa Forest West Wind Farm Community Fund. Small Grant Application Form Up To 10k

Transcription

1 The Brechfa Forest West Wind Farm Community Fund Small Grant Application Form Up To 10k Please make sure you fully review the Guidelines for Applicants before you complete this application. Please ensure you answer every question. Where a question is not appropriate to your organisation or project please write Not Applicable (N/A) For Office Use Only: Reference number.. Date of receipt Section 1: About Your Organisation Name of organisation Address of your organisation Address of contact person responsible for the project Contact details of person responsible for the project Post Code: Post Code: Home Phone: Mobile Phone: Other: Contact person s name & position in the organisation address: 1 QF107/v1/KH/

2 Are you a part of a wider organisation/affiliated to any National Governing Body? Yes/No (Delete as appropriate) (If yes please state which organisation/body) Organisation type (Tick where appropriate) Charity number (if applicable) Company number (if applicable) Is membership to your organisation and the project open to anyone who wants to join? Town/Community Council Community Group Society/Membership Organisation Charity Not for Profit Company Voluntary Organisation Social Enterprise/Community Interest Company (CIC) Club e.g Youth Club Company Limited by Guarantee Other Yes/No (Delete as appropriate) (If No please explain why?) How many paid staff do you employ? How many volunteers do you have? Full Time = Part-Time = Volunteers = Section 2: About Your Project Please describe your proposed project (maximum 200 words) (What are you going to do) 2 QF107/v1/KH/

3 Why is the proposed project needed (Maximum 200 words) Please explain how the communities within the area of benefit for the fund would benefit from the funding, including who, how, and the number of people that will benefit (Maximum 200 words) When is the planned project start date? When is the planned project completion date? 3 QF107/v1/KH/

4 Section 3: Proposed Project Financial Details Expenditure Cost VAT Total Total Project Cost = Other Grants Applied for/received (please list) = Brechfa Forest Wind Farm grant requested = Is your Organisation registered for VAT? (If yes; you will be expected to reclaim VAT on your project and any grant paid will exclude the VAT element) Yes/No (Delete as appropriate) VAT Number. Section 4: Project Check List Please ensure the following documents have been included as part of your application for the Brechfa Forest Wind Farm Community Fund Copy of organisation constitution Equal Opportunity and Language Policies Written quotes or estimates (x 3 needed for single items over 5K) Copy of last available accounts Last 3 months bank statements 4 QF107/v1/KH/

5 Evidence of community support for proposed project e.g Letters of support etc. (5 max) Copy of any planning permission or listed building consent (Please refer to your local Fund Manager if any of the above is not available/applicable) Bank Details Account Name: Bank Name & Address: Sort Code: Account Number: Names of authorised signatories: 1: 2: To be completed by a representative of the organisation/group: I confirm that all the information on this form is true and correct. Representative s name: Position: Phone Number: Signature: Date: Data protection. Information provided on this form will be processed by the administrator solely for the purposes associated with the management of the Brechfa Forest West Wind Farm Community Fund. 5 QF107/v1/KH/

6 Please return completed application form and supporting documents to: Name-: Kevin Harrington Postal address-: Antur Teifi, Antur Teifi Business Park, Aberarad, Newcastle Emlyn, Carmarthenshire, SA38 9DB Or to -: For further information/advice please contact Antur Teifi using the above contact details. 6 QF107/v1/KH/