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KEYNSHAM TOWN COUNCIL
GRANT APPLICATION FORM
A
APPLICATION SUMMARY
Name of organisation
Name of bank account
Name of contact
Amount requested from Keynsham Town Council
Account number Sort code
Telephone
Total project/event/item cost (if applicable)
FaxEmail
Address of organisation
Address of contact (if different from above)
Reason for application – brief project/event/item description:
This should be the name of the person/organisation you wish
cheques to be made payable to.
If you would prefer to receive your payment via BACS please fill in your bank details
£ £
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If you are a membership organisation, please provide the following details:
Membership
B
THE ORGANISATION
Number of adult members Number of junior members
Number of members resident in the town of Keynsham
Number of adult members
Number of junior members
If yes, please supply details of the membership scheme and charges applicable:
What is the main purpose of your organisation?
What activities are available for members?
Is the organisation restricted in any way? If yes, please provide details:
Is your organisation afliated to any national or local organisation e.g. Sports Council? If yes, please
provide details:
Do you charge for membership?
Yes
No
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How many people in Keynsham do you estimate will benefit from your project/event/item?
Please indicate the age range of the beneficiaries of any award – e.g. children/youth/adult/senior citizens
(if applicable)
to
C
THE PROJECT/EVENT/ITEM
Description of project/event/item
What are the aims of the project/event/item?
(III) What was achieved at the last event, which you consider to have been of benet to the Town?
If the application is for an annual or recurring local event, please answer the following questions:
(I) For how many years has the event run?
(II) What was the estimated attendance at: last event next event
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D
PROJECT/EVENT PLANNING
Date that you propose to commence the project or hold the event:
What is the proposed duration of the project/event?
If the project is land or property related, what is the nature of the interest to be acquired or already
held? (If leasehold, please give the length of the lease and date of termination)
Is planning consent required?
Yes
No
Is planning consent required?
If planning consent has been granted, are any conditions attached?
Yes
No
Is yes, what is the status of your application?
Not yet submitted Submitted but not determined Granted
If yes, please provide details
Is your building listed?
Yes
No
If yes, have your received the appropriate building consent?
Yes No
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E
FINANCIAL DETAILS
Estimated total cost
£
Expenditure
£
Total
Please detail the components of your project/event/item(s) i.e. your budget or costings (submit on a
separate sheet if necessary)
ARTS £
HERITAGE £
SPORTS £
CHARITIES £
MILLENNIUM £
Total National Lottery
Contribution from National Lottery
£
£
£
Total other organisations
Contribution from other organisations - please specify
CONTRIBUTION FROM FUND RAISING EVENTS £
CONTRIBUTION FROM YOUR OWN RESOURCES £
Total self funding
Self funding
£ 0.00
£ 0.00
£ 0.00
£ 0.00
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Is your organisation registered for VAT?
Yes
No
Yes No
Does the estimated total cost of the project/event /item include payments
in kind? E.g. free labour, materials etc?
If yes, please provide details below i.e. assumed number of hours x hourly rates etc.
Total value assumed £
F
SUPPORTING STATEMENT
Why do you think the Town Council should support this application? Please note that you are required
to demonstrate a benet to some or all of the town’s residents. (All applicants to complete – please
continue in section G if necessary)
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G
ADDITIONAL INFORMATION
Additional information/comments
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Please note that the Town Council will take account of Best Value, its obligation to promote racial equality,
its statutory powers and accounting requirements in reaching its decision. The following information
(where applicable) is therefore required from all applicants for financial assistance (before the
application can be placed before the Grants Committee). Information may be provided on a separate
sheet if necessary.
Yes
N/A
Have you provided a copy of your organisation’s CONSTITUTION? (You may
dispense with this requirement if you have submitted a copy in previous
years and there have been no changes made since.)
Have you enclosed a copy of your latest audited or independently
examined accounts?
Yes
N/A
Have you enclosed a copy of your latest bank/building society/other
investment accounts statements?
Yes
N/A
Have you enclosed a copy of
conveyance/letting agreement/lease?
No
Yes N/A
Have you enclosed a copy of written permission from the
owner of any premises involved?
No
Yes N/A
Have you enclosed copies of cover notes/summaries for all
relevant insurances?
No
Yes N/A
Have you enclosed evidence of any secured funding or
application for any other funding?
No
Yes N/A
If you have ticked Not Applicable, please explain why. Failure to enclose copies of accounts may cause
your application to be delayed or rejected.
If you have ticked Not Applicable, please explain why. Failure to enclose copies of account statements
may cause your application to be delayed or rejected.
Please confirm that statutory obligations under the Human
Rights Act have been considered.
Yes
Please confirm that statutory obligations under the Disability
Discrimination Act have been considered.
Yes
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Please confirm that you have considered all health and safety issues for this
project/event/item and carried out risk assessments for all relevant areas.
Yes
N/A
Please confirm that you have considered the environmental effects of this
project (e.g. carbon emissions, waste etc.) and give details
Yes
N/A
The Town Council has an obligation under s.17 of the Crime and Disorder Act to consider the impact of
all its functions, activities and decisions on crime and disorder in its area. What implications will your
project have for this requirement and how in particular will it assist the Town Council to meet
its obligations?
Grants are normally given conditionally on the organisation’s public acknowledgment of the Town
Council’s assistance. How do you intend to do this? (Please note that you may be required to provide
copies of relevant publicity materials).
Grants are normally given conditionally on the organisation’s agreement to allow its details
to be used in the Town Council’s website, publications and other materials. Do you agree
for your organisation’s details to be included? (Please note that personal and nancial
details will not be published)
Yes
Our organisation agrees to adopt and follow the ethos of a single use plastics policy
(sample policy template attached) and where possible limit the use of single use plastic
based products in its activities.
Yes
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Please note: the information provided on this application will be held on a database and used to provide
information to officers and members of the Town Council.
Your application may be submitted by fax or email but you will be asked to sign it before any approved
funding may be released. Remember that completed applications and supporting information must be
received by the Town Council no later than Friday 31st July 2020
Please return your completed form and supporting documents to Dawn Drury:
BY POST
Dawn Drury
Deputy Town Clerk
Keynsham Town Council
15 – 17 Temple Street
Keynsham
Bristol BS31 1HF
BY FAX
0117 9866359
BY EMAIL
deputytownclerk@keynsham-tc.gov.uk
If you need anymore information please call 0117 9868683
I certify that the above information and the contents of the attached documents are correct at the
time of applying. I understand that if any of the information is subsequently found to be incorrect this
may lead to the organisation being disqualified from consideration and/or the withdrawal of any grant
awarded. I agree to my organisation being bound by the eligibility criteria and any conditions set by the
Town Council.
I hereby declare that I have the authority to submit this application on behalf of the organisation
detailed above .
H
CERTIFICATION
Signed
Name (block capitals)
Status (e.g. Chairperson, Secretary )
Date
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APPLICATION CHECKLIST
The following Check List may assist you in completing your Grant Application Form. Applicants are advised
to read through the list below before submitting their completed forms.
Have you completed ALL sections of the form? (If you are unable to complete any part of the form,
please indicate why in your supporting statement, or write ‘not applicable’ where appropriate).
Does your application set out how you meet the requirements of the ‘eligibility criteria’?
Have you signed the declaration and certification on page 10 of your application form to certify that
all the details are correct?
Does your application explain how Keynsham residents would benefit from any grant awarded to
your organisation?
Is your grant application within the £1,000 limit?
Have you enclosed your Organisation’s latest set of accounts and constitution? (If you are unable
to provide these for any reason, you MUST indicate why in your supporting statement. If you have
provided a copy of the Constitution in previous years, and there have been no changes, you may
dispense with this requirement).
Decisions on who wil be receiving grants will be made in August.
Successful applicants will be expected to attend the grants presentation evening (to be held in
October if it is safe to do so) to give a brief description of their organisation and the grants purpose.
This will enable them to raise their prole and encourage networking with other Keynsham groups.
Please return your form as soon as possible and no later than Friday 31st July 2020 - late applications
will not be considered.
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