WEST KENT EXTRA LINDA HOGAN COMMUNITY FUND

Similar documents
CROYDON PARTNERSHIP Youth Opportunity Community Grants

DIPLOMA IN DENTAL HYGIENE AND DENTAL THERAPY APPLICATION FORM FOR ADMISSION IN Jan 2017

Equality Information 2018

EMPLOYMENT APPLICATION FORM

KENYLINK SERVICES LTD.

Registering as a dentist with the General Dental Council (EU/EEA/Switzerland)

Improving urgent care services in Walsall

Non-routine Medicine Funding Request (NMFR) Form Effective September 2017

irtec Assessor Award Application Form

East Lynne Medical Centre

The Church of England Professional Qualification for Headship Application Form, Reference and Statement of Sponsorship

EXAMPLE COMPLETED FORM

Grant Application. Friends of the Elderly Ebury Street London SW1W 0LZ

JOSEPH LEVY EDUCATION FUND

Consultation on proposals to introduce independent prescribing by paramedics across the United Kingdom

AHRC FIRST WORLD WAR PUBLIC ENGAGEMENT CENTRES. Research Fund Guidance Notes

People and Communities

To Patients and Carers of patients registered with GP Practices in Welwyn and Hatfield except for Spring House Medical Centre

CC1 - COMMUNITY CHEST APPLICATION FORM

Registering as a dentist with the General Dental Council (Overseas qualified)

Welcome to Church Lane Surgery / Dymchurch Surgery

This is a reference guide to the full application form and should not be filled in. You will need to apply online.

Applicants should read the Guidance Notes carefully before completing this application form.

International Programme for Organisations SAMPLE Application Form

Registering as a dental care professional with the General Dental Council

Warrior Programme Veteran Assessment & Registration Form

IRB STRENGTH & CONDITIONING LEVEL 1 APPLICATION FORM 2014/15 Season

Women s Vote Centenary Grant Scheme - Large Grant Fund Round 1. This should be the same name as specified in your governing document.

Application Form. Welsh Government Learning Grant for Further Education 2014/15. student finance wales

Open University Undergraduate on Study Bursary

ARTS COUNCIL OF NORTHERN IRELAND MUSICAL INSTRUMENTS FOR BANDS SAMPLE APPLICATION FORM

Scotch Whisky Action Fund Tackling alcohol-related harms Application Form

Driving License (Card & paper counterpart)

Family doctor services registration

Community Safety Grant Funding. Application Form

ACORN HOUSE Initial Referral Pack

LBR CPD funding 2013/ MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED)

A-Z Hospitals NHS Trust (replace with your employer name)

Arts Council of Northern Ireland Support for the Individual Artist Programme Application Form

Pennine MSK Annual Equality Report. For 2015

Equality, Diversity and Inclusion. Annual Report

Faculty of Health and Wellbeing LBR CPD funding 2012/ MENTOR PREPARATION FOR THE HEALTH PROFESSIONS (NMC APPROVED)

WORKFORCE RACE EQUALITY STANDARD (WRES)

TRUSTS / PRIVATE ORGANISATION - PLEASE COMPLETE:

Application for incorporation as a Scottish Charitable Incorporated Organisation (SCIO): application form and guidance notes

Application to be restored to the register

Responsible Gambling Trust Data Reporting Framework

NMC programme of change for education Prescribing and standards for medicines management

Family doctor services registration Postcode:... To be completed by your doctor

Application for Charitable Status: application form and guidance notes

ARTS COUNCIL OF NORTHERN IRELAND MUSICAL INSTRUMENTS FOR BANDS SAMPLE APPLICATION FORM

Community Grants application You could receive up to 1500 towards your community project!

CULTURAL ENTREPRENEUR PROGRAMME (CEP)

GPhC Registrant Survey 2013

PERSONAL DETAILS. Title: Mr / Ms / Mrs / Miss / Other (please specify)... Name:... Address:... Telephone number:... Mobile number:...

Application to be restored to the register

NHS England West Yorkshire Area Team 2014/15 Patient Participation Enhanced Service Reporting Template

John James Charitable Trust - Organisation Application Form

Graduate Entrepreneur Scheme

QMUL Unite Foundation Scholarship

1. GMS1 Medical Registration Form - Adult 16 years and over

Nottingham West CCG - Patient Survey 2017

Lloyds Bank and Bank of Scotland Social Entrepreneurs Programme

Bicton Heath, Shrewsbury, SY3 8HS

Equality Act 2010 Compliance Report

Patient Participation Report. Adelaide GP Surgery

Annex C Arden, Herefordshire and Worcestershire Area Team Patient Participation Enhanced Service 2014/15 Reporting Template

Standard Patient Experience Quarterly Report: Birmingham Community Healthcare Call Handling Service

You can complete this survey online at Patient Feedback Fill in this survey and help us improve hospital services

ARTS COUNCIL OF NORTHERN IRELAND NATIONAL LOTTERY PROGRAMME NORTHERN IRELAND MUSIC TOURING PROGRAMME APPLICATION FORM

EQUALITY AND DIVERSITY DATA ANALYSIS WORKFORCE INFORMATION SUMMARY REPORT

New Patients Are Always Welcome

Shaping Healthcare in Northamptonshire. Reviewing the way we support people with neuro-degenerative conditions in Northamptonshire

Arts Council of Northern Ireland Support for the Individual Artist Programme Sample Application Form

NMC programme of change for education Prescribing and standards for medicines management

Application form. Investing in Ideas

Community Safety Application

Ward Clerk - Shrewsbury

Standard Reporting Template

Director, Wates Family Charities

Application checklist

Solar Farms Community Fund APPLICATION FORM

Warrington & Halton Hospitals NHS Foundation Trust Annual Workforce Equality Analysis (2016)

APPLICATION FORM MEMORY CAFÉ/DEMENTIA SUPPORT GROUP GRANT

Black Country ESF Community Grants Application Form

Mummy s Star Grant Guidelines

Family doctor services registration

KILBRAUR WINDFARM COMMUNITY BENEFIT TRUST FUND (Scottish Charity No SC040268)

Future of Respite (Short Break) Services for Children with Disabilities

AW Surgeries. Patient Participation Report 2011/12

Public Sector Equality Duty: Annual Equality Data Monitoring Report Avon and Wiltshire Mental Health Partnership Trust

West Lancashire Freemasons Charity

Unite Foundation Scholarship Scheme 2018/19. Eligibility & Application Form

Annual equality, diversity and inclusion report

Little Owls Day Nursery Bank Nursery Assistant Role

Applying to join the pharmacist pre-registration scheme guidance and application form

Lloyds Bank and Bank of Scotland Social Entrepreneurs Programme

PLEASE PRINT THESE OFF and READ BEFORE STARTING YOUR APPLICATION

ASDA Carrier Bag Community Grants Application Form Guidelines

2014/15 Patient Participation Enhanced Service

Transcription:

WEST KENT EXTRA LINDA HOGAN COMMUNITY FUND GRANT APPLICATION FORM 2010 (Please refer to the grant application help with questions pages and the guidance notes) 1. Name of your organisation 2. Name of your project (if different from above) 3. Your contact details Contact name and position in your organisation/group Address (with postcode) Phone and Fax Email / Web address 4. Summary of the purpose of your grant 5. Which of our aims does your application match (please tick box) Debt prevention, money management advice, reduction of poverty Opportunity for and/or support of volunteers and volunteering Activities/services for older people Activities/services for young people and children Activities that promote community engagement and cohesion 1

6. How much money do you need? Total cost of the project you are asking West Kent Extra to support Amount you are requesting from West Kent Extra How much have you raised so far 7. Please give us a breakdown of how the grant would be spent ITEM/ACTIVITY AMOUNT Total amount requested If this is not the total cost of your project: Who else will be giving you money? What is that for? 8. Who should cheques be made payable to? 9. Tell us about your organisation Are you a registered charity (if not what are you)? How long have you been established? How are you managed? 10. Who is involved in running your activity? How many paid staff do you have? Full time: Part time: How many volunteers? Full time: Part time: 11. Location Where is your project based? In what areas do your beneficiaries live? 12. About your project, please tick the box next to the description that best matches your group A new group doing a new project An existing group expanding services and activities Existing group and/or project reaching new people 2

13. Please tell us about the people who will benefit from the grant How many people do you anticipate will benefit from your activity 14. What is the duration/timescale (including start and end dates)? 15. Please circle the box/boxes that best reflect the ethnic origin of most of the beneficiaries White British Black Caribbean Indian Bangladeshi Mixed Race Gyspy White Irish Black African Pakistani Chinese Traveller Other 16. What ages are the people who will benefit from the grant? Under 1 1 to 4 5 to 11 12 to 18 18 to 25 25 to 59 60 + 17. How would you describe the people who will benefit from the grant? Living in rural area Disabled Older People On low income Living in urban area Unemployed Young people Vulnerable 18. How will this grant meet one or more of the aims of West Kent Extra (see question 5)? 19. CRB Checks and Child Protection Do all staff and volunteers who have unsupervised access to children, young people or vulnerable adults have enhanced level CRB checks? YES NO If applicable, does your organisation have a child protection policy? 20. How will you attract members/users to your group? YES NO N/A 21. How will you measure the success of your project? 3

22. How will this project make a difference: To the people that take part To the area or local community 23. What is the total annual income and expenditure of your organisation (please enclose a copy of your most recent annual accounts if available) Please state below which period this covers. Accounts from Accounts to Total Income Total Expenditure What reserves (surplus funds) does your organisation hold? Restricted Unrestricted What other funding applications have you made? Organisation Request/Amount Made Amount Received 24. Declaration of Interest Please tell us if you have any relationship, association or interests with any staff, projects or businesses connected to West Kent. 25. Your signature, this must be the signature of the main contact in question 3. I confirm to the best of my knowledge and belief, that the information in this application form is true and correct. I understand that you may ask for additional information at any stage of the application process. I agree that, if appropriate, I will provide photographs of my project. Signed Date 4

26. EQUAL OPPORTUNITIES STATEMENT (Name of organisation) Recognises that everyone has a contribution to make to our society and a right to equal treatment. We aim to ensure that no organisation or individual involved with our organisation will be discriminated against by our organisation on the grounds of: Race, colour, nationality or ethnicity Sex, marital status or caring responsibility Sexuality Age Physical, sensory or mental health disability Political belief or religion Class Health status Employment status Please note that if you have an Equal Opportunities Policy you may prefer to enclose a copy instead of signing the Equal opportunities Statement. I confirm that my organisation is committed to equal opportunities Signed (on behalf of the organisation) Designation: 5

27. INDEPENDENT SUPPORTING STATEMENT Name Occupation Contact address Telephone Email How do you know this group I have read this application and support the request for funding. I am willing to be contacted to discuss this application further. I am also willing to comment on the grant at a later date, if the application is successful and to provide a written report if required. Signature Date Please return this form to; Linda Hogan Community Fund 101 London Road, Sevenoaks, Kent TN13 1AX Tel: 01732 749420 This document is available in large print 6