Community Facilities Grant application Instructions Please use this form for applications for Community Facilities grants up to £10,000. Group details Group name Project name (if different) Contact person This must be someone from your organisation who knows about your project and can be contacted during office hours. This is normally the person completing the form. Position in the group Address Postcode Email Phone Specific communication needs such as large print, textphone, sign language, other language. Next Page About your organisation When was your group established Type of group Registered charityExempt or expected charity registered with the Inland RevenueCompany limited by guaranteeCommunity group/club/societyOtherOther - text entry Registration or company number where relevant Organisation purpose: brief description. Describe the usual activities/ services you provide. If you are a new organisation, describe the services/activities you plan to provide. Name of one reference: for example local councillor, police officer, religious group leader or individual who does not have a vested interest in your group Reference address Reference postcode Does the group or any member thereof have a direct or indirect interest with a Wycombe District Council councillor or officer? NoYes, please provide details Detials of interest with Wycombe DC councillor or officer. Previous PageNext Page Your project Tell us about the projects/activities you are planning. What project or activities will take place if you receive a grant? Try to be specific about what you will do and how you will do it. Tell us how you have identified the need for the project, either within your group or community and how you think your project will meet this need. Tell us why we should be funding your activity Where will your activities take place? Please explain how you know that people in your community want this project and what difference you hope the grant will make? What is the timescale of your project? List key activities and dates. How many people do you expect to benefit directly from your project / service/ activity? Please give a number, do not put ‘everyone in the area’. An estimate is fine if you cannot be exact How will the success of the project/activity be measured? What are the main risks for the success of the project/activity and how will these risks be managed, eg health and safety, finanacial challenges. Previous PageNext Page Linking with our priorities We have key aims and objectives which define priority areas of work. These priorities will positively contribute to our vision for the Wycombe district to be economically strong and the place to live, work and visit. Please explain how you will meet the relevant outcomes for each priority. Regeneration and Infrastructure • Deliver development projects • Sustainable balance between homes, jobs and infrastructure • Improving the vibrancy of High WycombeCohesive Communities • Engage with younger people to meet needs and aspirations • Engage with residents to shape their local area • Encourage safe communities and strong social cohesion • Ensure targeted and affordable help for those most in need • Ensure private housing standards are acceptable • Address affordability gapsValue for Money • Provide Council services in the most efficient and accessible ways • Generate new revenue streams for the Council • Consider new development opportunities for the Council • Improved benefit to public services Regeneration and infrastructure Cohesive communities Value for money Tell us how much money you need for your project/service and provide a breakdown of what the money is for. Please use general headings. In Column A tell us how much funding you are requesting. In column B tell us about the total cost. (A detailed breakdown should be shown on your income & expenditure and project budget). Remember to add VAT where it applies. Please total all columns. These totals will tell us whether there is a gap between the total cost and the grant you are requesting from us. If your group has received a grant from Wycombe District Council in the last five years, please give details. Please describe what contribution you will be making towards the cost of the project/activity. Please provide details of other organisations you are applying to for this project/activity or have already received grants in support of this. Previous PageNext Page Value for money Please demonstrate how you will deliver your activities in an efficient and cost-effective way. If your group has financial reserves, for what purpose are they held? If your reserves are more than the amount you are requesting, please explain why you are making this application. Previous PageNext Page Bank or building society details Please double check that the information you provide is accurate. Your group's account name You can only apply for a grant if you have a bank/building society account in the name of your group. Bank or building society name Bank or building society address Sort code Account number or building society roll number Authorised signatories We will only pay grants into an account which requires at least two people to sign each cheque or withdrawal. It is recommended that these people should not be related. Authorised signatory 1 Position 1 Authorised signatory 2 Position 2 Authorised signatory 3 Position 3 Authorised signatory 4 Position 4 How many people have to sign each cheque or withdrawal from this account? Declaration I confirm that to the best of my knowledge and belief, all 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. If an application is knowingly submitted with false information it will be disqualified and be withdrawn. Name Position Date Checklist We will only process your application if: • You complete all the relevant questions on the form • The proper people sign the form • You enclose all the necessary documents Constitution or set of rules List of Committee Members (showing names and positions) Equal Opportunities Policy (if appropriate) Child Protection Policy (if appropriate) Vulnerable Adults Policy (if appropriate) Projected income and expenditure and overall budget for this activity/event Copies of relevant insurance certificates Copies of quotation 1 Copies of quotation 2 Copies of quotation 3 Previous Page Submit