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A1 *Name of organisation
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A2 Your organisation address *Address1:      
  Address2:    
  Address3:    
  Town:    
  County:    
  *Postcode:    
A3 *Please select what type of organisation you are
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A4 Enter registered charity or company number
      
A5
If you are not a registered charity or company, please click YES to confirm that you are registered for tax purposes in the UK only. This is a legal declaration and you must read the Help text for this question to ensure you are making the appopriate declaration.

Please see the Help text for more information.
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A6 *Year Established
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A7 *Telephone number
If you only have a mobile number, enter this here.
        
A8 Mobile Number
        
A9 *Contact name
         
A10 *Your email address
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A11 Your address *Address1:     ?
  (If this address is the same as the Organisation address, please leave blank) Address2:    
  Address3:    
  Town:    
  County:    
  *Postcode:    
A12 *What is your Job Title in the organisation?
      
B1 *What does your organisation do?
2,700 characters
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B2 *Please tell us about your local area and its problems
2,700 characters
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B3 *The Impact of Your Work
(2,700 characters)
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B4
Case History

(2,700 characters)
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B5 *Total number of clients/users of your services in the past 12 months
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B6 *Describe the work or project for which you are applying for a grant
What services, posts or activities would a grant pay for? (2,700 characters)
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B7 *How many users/clients will benefit from this work or service over the next 12 months?
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B8 If this is a new project, service or employee role, how and why have you decided it is needed?
(1,000 characters)
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B9 *How are people made aware of your services?
(1,000 characters)
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B10
*How will you encourage people to participate?

(1,000 characters)
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B11 *What other local organisations, statutory or voluntary, do you work with whether formally or informally?
(1,000 characters)
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B12 *What is the total cost of the work or project?
(Must be under £250,000.)
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B13 *What funds have you secured to date?
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B14 *What is the grant amount you are requesting?
Must be between £2,000 and £7,500; cannot exceed 50% of the total cost: please see also Help information.
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B15 *Who else is funding this work?
List the confirmed funders of this work
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B16 *What was your total annual income in your last financial accounting period?
(Must be under £250,000: see Help information.)
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B17 *What was your total annual expenditure in your last financial accounting period?
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B18 *What methods will you use to measure your success?
(1,000 characters)
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B19 *What are your measurable aims for this work?
(1,000 characters)
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C1 Please give a brief description of the way in which your organisation is governed and managed.
You do not need to give this information if your Annual Report & Accounts give a detailed description of your organisation's governance. (2,000 characters)
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C2
*Tick to confirm you have a safeguarding policy which is given to all trustees, staff, volunteers and clients

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C3
*When was the written policy, plus the procedures and measures to implement it, last reviewed?

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C4
*When was the last training/refresher session on safeguarding conducted with staff/volunteers?

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C5
Please describe how you handled any reportable incidents within the past 24 months

(4,000 characters)
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C6
If you provide no direct services to children or vulnerable adults, when did you last review the safeguarding policy and record of third party organisations with whom you have a formal connection?

(For example, you might own and run a venue used by third party organisations or you commission services from other organisations.)
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C7 Tick to confirm all your staff are vetted through the Disclosure and Barring System (DBS)
If staff are not vetted, we may contact you for further details
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C8
Explanation of Reserves

If you have low unrestricted reserves (less than 2 months' costs) or high reserves (more than 6 months') give your explanation here
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D1 *Please upload your latest annual accounts here
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D2 *Please upload a budget for all the costs of the work/project for which you are applying.
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E1 *Click to confirm that all the information given on this form is correct and current
Important: you must read the Help text on this question to understand your responsibilities in making this application.
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