Ashley, Easton and Lawrence Hill Neighbourhood Partnership

Wellbeing Grant Application Form

1. Does your project work with community members from one or more of the following communities: (tick yes or no as appropriate)

Yes NoAshleyEaston

Lawrence HillYour contact details:

2. Name of your group or organisationContact address: Post code:

Telephone number: Email Address:

Name of the contact person within your group or organisation:

About your group/organisation:3. Please tell us briefly about your group or organisation. (appx 100 words)

4. How are residents of Ashley, Easton & Lawrence Hill involved in your work? (appx 100 words)

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About your project:5. What is the name of your project?

6. Who is the project aimed at?

7. Please provide a brief description of your project (appx 150 words)

8. Please tell us how you are currently involved with the group(s) your project is targeting: (appx 100 words)

9. What criteria(s) does your project address? (Please see the accompanying small grants criteria letter for full criteria details and tick all that apply)

Criteria: Tick below1) Activities that focus on young people making their voice

heard in decision-making and encouraging young people of Ashley, Easton & Lawrence Hill to have a greater stake in their communities.

2) Work, which fosters positive relationships between children and young people from different neighbourhoods.

3) Activities that encourage local people to become more involved in and have a greater say about where they live.

4) Events/activities, which bring together people from different cultural backgrounds who would not normally come together.

5) Sharing skills and knowledge – projects, visits, and skill swaps.

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10. What activities or methods does your project use to address the above criteria? Please provide an explanation below for each criteria you claim your project is addressing:

Criteria Number

Activities or methods:

11. What outcomes do you expect from your project? (appx 150 words)

12. How many people will be directly and indirectly impacted by your project?Directly: Indirectly:

13. How will you make sure your project is of benefit to the relevant equalities communities in the area? (Older people, young people, black and minority ethnic people, lesbian, gay and bisexual people, disabled people, women or other disadvantaged groups)? Please tell us as much as you can – you can attach additional sheets of paper if you need to.

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Project activities and timeline:14. Please provide a breakdown of your project’s key activites and deadlines below:Activity Responsible

individual (s)Deadline

15. Please tell us the start date and end date for your project:Start date: End date:

16. Based on the planning you have already done for your project, will you be able to start your project immediately if you receive funding? (tick yes or no)

No Yes

17. If you answered no to question 16, what questions or unknowns do you need to answer before starting your project?

Project Budget:18. How much money are you asking for? £

19. Please set out a breakdown of the total costs of your project, showing us which items you are asking us to fund and which are being funded from another source.

Item Cost Please tick if you are asking us to fund this item.

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Total CostRequired Documents:

Your organisation, or your partner organisation, is required to have the following documents. You are not being asked to submit copies of these documents alongside your application, you are just being asked to confirm whether or not you have them. The Neighbourhood Partnership will do occasional “spot checks” to confirm these documents exist for applicant organisations.

If you would like to apply but need help developing these documents for your group, please let us know and we will do our best to assist you.

Please confirm, by checking yes or no, whether or not you (or your partner organisation) have the following documents:

No Yes

20. A formal constitution (set of rules for your group)21. An Equal Opportunities Policy22. A Health and Safety Policy23. Safeguarding Policy – required if your project involves working with children, young people or vulnerable people.24. Public Liability Insurance – required if your project involves working with members of the public. (If you do not currently have Public Liability Insurance, you can include the cost in your budget to purchase this insurance as part of your project costs)

Bank Details:25. Does your group have a bank/building society account and do cheques need to be signed by two or more signatories? (tick yes or no)

No Yes

26. If you can answer Yes to questions 20 and 25, complete the box below. If one or both of your answers to 20 or 25 is No, please answer question 27.

Name of account: Bank/building society:

Branch:

Account number:

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Branch sort code:

Please give us the details of your bank/building society account into which we should pay a grant if you are successful27. If you answered No to questions 20 or 25 above, we will want to pay your grant through a formally constituted group if your application is successful. Please tell us below which group will receive a grant on your behalf for this piece of work.

Address:

Name of the group: Name of account: Bank/building society:

Branch:

Account number:

Branch sort code:

Please give us the details of this group’s bank/building society account into which we should pay a grant if you are successful.28. Please ask the Chair, Treasurer or Chief Executive to sign below to confirm that they are willing to receive the grant on your behalf:

I confirm that my group has agreed to receive a Neighbourhood Partnership Wellbeing Grant on behalf of this group.

Name:

Position:

Group/organisation:

Signed: Date:

Declaration29. Name of person submitting the form:

Signature:

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Name: Date:

Position in the group or organisation:

30. For organisations with a Management Committee: Signature of the Chair of the Management Committee (or another member of the Management Committee if the Chair is completing this form). If you are not a formally constituted group, this application must be signed by another member of your group:

Signature:

Name: Date:

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Checklist, please make sure you have:

Read the guidelines

Answered every question

Enclosed a copy of your constitution, Equal Opportunities Policy and Health and Safety policy

Enclosed any other relevant information (e.g. safeguarding policies, public liability insurance)

Completed details of your bank account

Signed the form and had it countersigned

If necessary, obtained the details and signature of a constituted organisation to receive your grant on your behalf if you are successful

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