Stockton Borough Community Fund

Stockton Borough Community Fund Group Application Form

Stockton Borough Community Fund Group Application Form The Stockton Borough Community Fund is administered by Tees Valley Community Foundation (TVCF), it is for voluntary and community groups based within the Stockton on Tees Borough and is for a maximum of 500. Only one application can be made in any twelve month period. Before you start filling in this form make sure you have red the guidelines for this fund. There are also 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 September 2012. 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. If you have any questions please contact one of our Client Case Officers by:

Stockton Borough Community Fund application checklist Our Client Case Officers can be contacted on 01642 260860 or info@teesvalleyfoundation.org 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? Are you based in Stockton on Tees 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 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. Please read our full guidelines before continuing with the application. 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 Located in Stockton on Tees About your project: YES NO Is your application for under 500 Will your project be completed within 12 months of receiving a grant? If you answered no to any of question in part two please contact our office to discuss as we may not be able to fund your project.

Section 1: About your Group/Organisation 1. What is your group/organisation s name and address? Name of Group/Organisation Address of Group (please include postcode) Question 1 Give the full name as it appears on your governing document. Tell us your organisations main address, including postcode. Which geographical area does your group do most of its activities in? 2. What type of group/organisation are you? (please tick as appropriate) Voluntary or community group School Parish or town council What area (ie ward or town) do your activities take place. Question 2 Please tick on box only. We explain what we mean by voluntary and community organisations in our guidance notes. Community interest company Registered company Registered charity Other If other please provide details: Please provide relevant registration numbers A) Charity Number (if applicable) B) Company Number (if applicable) Question 3 Please provide your charity, company or DfE number if applicable. DfE stands for Department of Education. C) DfE Number (if applicable) D) When did your organisation start? D) Are you a branch of a larger organisation? YES NO If yes, what is the name of the larger organisation? If you are a branch of another organisation that has management and financial control over you they may have some legal responsibility if we give you a grant. What is the address of the larger organisation? Postcode

Section 1a: Your Governance & Membership 1. Your Membership Are there any restrictions on who can join your organisation? YES NO If yes please explain: 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. 2. 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? 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? Do you employ any staff? YES NO If yes how many? Full Time Part Time 3. Organisation details What is the charitable aim of your organisation/group? What are you usual activities?

5. Does your bank of building society account meet our requirements? 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 Building society roll number (if appropriate) Account Number Does your constitution (set of rules) show the power to raise funding? YES NO If no why not? Question 5 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. 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 SUPPORTING DOCUMENTS. 6. Provide a summary from your most recent accounts or financial statements Are the figures you are providing below from: or Your latest accounts or financial records of your organisation? Projected because your organisation has been running less than 15 months? Account year ending: dd/mm/yyy Question 6 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. 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 If yes, how much? No 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.

7. Who is the main contact for this application? Title Forenames (in full) Surname Position in organisation Date of birth: dd/mm/yyyy Address Postcode Landline number Second contact number Email address Which address should we use to notify you of our decision? Question 7 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). The date of birth and address helps us to prevent and detect fraud. 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 The main organisations address in question 1 Or The address in this question Do you have any communication needs? If yes, what are you communication needs? You can write up to 200 characters with spaces (about 20 words) These might be textphone, sign language, large print, screen reader, audiotape, Braille or a community language. 8. Safeguarding Children: YES NO Vulnerable Adults: YES NO 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? 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 will also ask questions around these policies so please ensure whoever is completing the form is aware of this. Are you staff & volunteers CRB checked?

8. Your Project Please describe your project or activity. What do you want to do with this grant? (maximum of 300 words) Question 8. 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. When will the project/activity start? Finish? How many people do you expect to benefit form your project/activity and in what ways? (max 200 words) We need to be able to assess the value of your project, please tell us how many people will benefit and in what way. How will you judge the success of your project? (max 200 words) 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. If this is an ongoing project/activity, how will you pay for it in the future? (max 50 words) Will you be able to continue with you project/activity once this grant is used?

9. How much money are you going to need? What is the total cost of the project/activity? Please provide a breakdown of the project budget: Item or activity Question 9. You need to supply details of all of the items you wish to buy in the table in this section. How much are for from this fund? If you are not applying to this fund for the total cost of the project how do you intend to finance the rest? Maximum grant is 1,000 as small grant. If you require more then you need to complete a general grant application as this requires more detail. Please show us in table below any other funds that you have applied to for this project: Name of Fund Amount Applied For: 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) Is there anything additional that you would like us to know in relation to your application? (Max 200 words)

We agree to abide by the following terms and conditions: 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 repaid. 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.

CHECKLIST FOR: (insert name of applicant) 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 they named contact on the application is able to answer any queries we may have. As this is a small grant application form we do not need to see supporting documents, however you may be asked to present these at a later date so please ensure that you have answered all the questions correctly. You may email your application to either: a.skinner@teesvalleyfoundation.org or l.leather@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. 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. 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: (if emailing please type by email ) 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 Registered Charity No. 111222 Registered Company No. 5478088