Application Form
Please ensure you read the Small Grants Guidance Notes prior to completing this application form
Section 1 - About your organisation
Name of organisation:
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Lead contact: .............................................................................................................................................
Position in organisation: .............................................................................................................................
Contact address: ........................................................................................................................................
Contact email: ...........................................................................................................................................
Contact telephone: .....................................................................................................................................
Is your organisation not-for-profit and constituted with a bank account? YES NO
Is a copy of your organisation’s constitution enclosed?
YES NO
(see guidance notes)
Section 2 - About your project
Project name:
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Project start date: .......................................................................................................................................
Project end date: .......................................................................................................................................
(Projects must be delivered between 1 April 2017 and 31 March 2018)
Which of the following priorities does your project address?
Inactive Active
Social Isolation
Affordable Warmth
Anti-Social Behaviour
SMALL
GRANT
SCHEME
How have you identified the need for this project? .........................................................................................
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How will your project address this need?
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Who will your project benefit and how will you identify them?
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How many people will it benefit? .................................................................................................................
How will you ensure you meet this target? ....................................................................................................
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Section 3 - About your costs
How much is your project going to cost and how much do you need from the Small Grant Scheme?
Item
Total cost of
item
Amount
requested from
Small Grant
Scheme*
Amount
of match
funding
Source of match
funding
Secured
Y/N
£ £ £
£ £ £
£ £ £
£ £ £
Total £ £
* The total amount requested from the Small Grant Scheme must not exceed 75% of the total cost of the project
and must be between £500 (minimum) and £2,500 (maximum)
Does the grant requested replace statutory funding that has been withdrawn
? YES NO
Section 4 - About your outcomes
How will your project make a difference to people’s lives? (list up to 3 outcomes)
1. ............................................................................................................................................................
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2. ............................................................................................................................................................
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© Communications Unit HDC 2017
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How will you measure success? ...................................................................................................................
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What longer term health and wellbeing benefits will your project achieve?
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Lead contact signed:.........................................................................................Date:
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Senior Officer signed*: .....................................................................................Date: ..........................
*this must be someone different to the lead contact
Please return to: Peter Cole, Hambleton District Council, Civic Centre, Stone Cross, Northallerton DL6 2UU
Deadline for applications: Friday 2 June 2017
01609 779977 hambleton.gov.uk
The text of this document is available in large or single colour print
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