Commissioner’s Community
Action Grant
Organisation Name
Project Name
Amount Requested
Length of Grant
Max. 12 months
Submission Deadline Small Grant Round 7
Friday 4
January 2019
Submission Deadline Small Grant Round 8 Friday 1
March 2019
Submission Deadline Small Grant Round 9 Monday 1
July 2019
Submission Deadline Small Grant Round 10 Friday 1
November 2019
When complete email to:
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The Police & Crime Commissioner for Derbyshire’s
Community Action Grant
This application form is for non-statutory organisations such as voluntary and community
groups and non-profit making organisations applying for a Community Action Grant. Before
completing your application, please make sure you have read the Guidance Notes and
Information and the Standard Grant Conditions available at
Small Grants
To take part in any small grant round you must submit the application by 12 noon on the
deadline date stated at the front of the application. Electronic submissions are preferred where
possible but a signed hard copy is also acceptable.
The electronic copy to be sent to
The signed hard copy (if applicable) of your application should be sent to:
Office of the Police & Crime Commissioner for Derbyshire
Constabulary HQ
Decisions will be made in line with the timetable which is available on the grants page of the
PCC website, and both successful and unsuccessful applicants will be advised of the outcome
on the decision date specified.
If you are successful, we will then ask to see some of the supplementary information referred to
in the application form (e.g. accounts and safeguarding policy where available). Subject to
satisfactory checks we will send you a grant agreement to sign.
Applications received after the deadline stated will not be considered.
When completing the application, please:
Adhere to the word limitsadditional text will not be considered
Respond appropriately to each question only information provided in the answer boxes will
be considered
Be aware that applications are assessed solely on the information given in the application
Assume that assessors have no prior knowledge of your organisation or project
Place a tick in the required boxes as appropriate
We encourage use of Arial 11pt typeface if completing your application electronically
Do not enclose any additional information unless we request it
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Section 1Your Community Action Grant proposal
The following details will be used to initially shortlist projects so please ensure that you
include all relevant information requested (Max 160 words per box, Arial 11pt typeface)
Please ensure you provide statistical data where possible and include both qualitative and
quantitative information. (You will be able to expand on this information further in the following sections).
Summary of proposed project:
Evidence of need for the project:
Who will benefit and how (clear outcomes):
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Police and Crime Plan priorities
Your proposal must relate to at least one of the priorities detailed in the Police and Crime plan. The full
Police and Crime Plan document can be found here
on the Grants page of the Commissioner's website.
Using the following tables, please identify briefly how your project links to one or more of these priorities
Which of the following Police and Crime Plan priorities does your application support?
(Please ‘X’ all that apply)
Priority Number
Priority Explanation
Please ‘X’ the
Appropriate Choice
Working to keep the most vulnerable
in our communities safe from crime
and harm and supporting those who
unfortunately find themselves a victim
of crime.
Working to tackle the emerging threats
of cyber and cyber enabled crime on
individuals, businesses and
Working to tackle the impact of drugs
and alcohol on communities.
Supporting those with mental health
issues, including those with learning
difficulties, who come into contact
with the Criminal Justice System, as
victim or offender, to get the right
support, from the right agencies at the
right time.
Working with young people, including
those who have been either victims of
crime or offenders, to understand their
needs and prevent them becoming
involved in criminal activities.
Working with the Constabulary to
develop the policing family to be more
representative of the diverse
communities it serves.
Working with the Constabulary and
partners to maximise the opportunities
from developments in technology.
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To help you complete the tables below, please see additional information:
ACTIVITYBriefly describe the need for the project and who will do what and how
PERFORMANCE MEASURESBriefly describe what tools you will use to demonstrate the
change that your project achieves
OUTCOMEBriefly describe the anticipated outcomes of each project
IMPACT AND BENEFITPlease state what impact the project will have on the local
community and who will benefit from it. Please be as specific as you can. This may be used as
delivery criteria for payments.
The Commissioner will be looking for:
Projects which empower the local community to tackle problems in their neighbourhood
Projects organised by (and involving) community/neighbourhood groups.
Projects that can demonstrate that they can make a difference to local communities.
Projects that take a new approach to tackling long term problems.
Projects that foster good relations between partner agencies and communities and do
not work in isolation.
Additional information regarding eligibility criteria and other useful details can be found by
clicking here
What Activity Will Be Undertaken?
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Why Is The Project Needed And How Many People Would It Benefit?
What Is The Proposed Outcome?
How Will You Measure The Impact + Benefit?
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Which geographical location(s) will your organisation work in?
Derby City
Please specify:
Derbyshire County
Please Specify:
Policing Area (North or South
Is this grant for new work, or to support/extend your existing work?
If you are seeking a grant to support existing work, please explain below how and why your
existing approach(es) work well
EXIT STRATEGYIf you are successful what will happen to the project/service/activity when
the funding ends
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ADDITIONAL INFORMATION please give any other information you think is relevant to the
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Section 2 - Financial information
Please provide an explanation of what you will be spending the money on if your application is
successful. You don’t need to have a value in every box.
Please remember that the maximum size of the grant is £2,500 and that we need sufficient
detail to assess your application for good value for money and to identify how you plan to
make best use of the available funds.
Type of Spend Total Cost
Direct Staff Costs (Including oncosts)
(please provide a breakdown of costs)
(please provide a breakdown of costs)
Supplies and Services
(please provide a breakdown of costs)
Management Overhead
(please provide a breakdown of costs)
Monitoring and evaluation costs
(please provide a breakdown of costs)
Other (please detail) £
BREAKDOWN AND JUSTIFICATION OF COSTS Please use the box below to justify any
costs which you feel may appear high
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If the total cost of your project is more than the amount requested in the grant application,
please use the table below to explain where the remainder of the money will come from. If
partners are contributing to the finances of the project please also provide these details here.
Source of funding
Total amount
contributing to
project costs
Period of time
that match
funding covers
Can you supply
confirmation of
match funding?
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Section 3 – Your Organisation
Organisation Name
Please give the details of the person in your organisation who will act as the point of contact,
and who can discuss the application in more detail if required.
Title Surname
Forename(s) Position
Address (incl. postcode):
Telephone Telephone
Mobile Fax
Please tell us below of any communication needs your main contact has, including text-phone,
sign language, large print, audiotape, Braille or a community language.
Communication Needs
Please state the month and year in which your organisation was established
Month Year
Please briefly describe your organisation and what it does (maximum of 150 words)
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Please confirm the type of organisation as stated in the governing document, giving the
registration number where appropriate (please complete all those that apply):
Please state below the number of paid workers and volunteers currently in your organisation.
Employees Number Volunteers Number
Full-time paid Active
Part-time paid Not Active
Does your organisation have a set of rules, memorandum of understanding, or
constitution (Governing Document)?
Does your organisation have an active management team/board of trustees of
at least three people (who are unrelated)?
Does your organisation have a bank account in the name of the group, with a
least two unrelated signatories?
If no you will be required to set one up should your application be successful before any monies
can be paid.
Does your organisation have recent signed accounts?
Does your organisation have a policy on financial controls and management?
Does your organisation have appropriate policy/processes for safeguarding
Children and Young People and/or Adults?
If you haven’t got a safeguarding policy we may be able to help you get one if one is
Type of Organisation Registration Number
Registered charity
Not-for-profit company
Social enterprise
Company Limited by Guarantee
Unincorporated and not registered as a charity
(please put a tick in the box if applicable)
Other (please specify)
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What has your annual income and expenditure been in the past two years?
Financial year
Annual income
Reserves at the
end of the year
From To
If you are intending to deliver this project in partnership with other organisations, please advise
who they are and give a brief description of their role. Please only include partners if they have
agreed to be involved in the project (maximum of 50 words per partner). You need to be
prepared to provide evidence of their agreement.
Name of Partner Role
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Section 4 - Finishing your application
Please tick the following boxes to confirm that:
You have answered all of the questions in this application form
You have signed the application form
You have only sent us the information we have asked for and not included any
additional documents
You have e-mailed an electronic copy of this application form to
I confirm that I am authorised to sign on the behalf of the organisation and that all the
information given or referred to in this application form is true and accurate and that all relevant
information has been submitted.
Position in organisation
We are interested to know how you heard about the grant; please indicate all that apply:
Press article - please state publication
Public sector organisation please state
(Home Office, Local Authority, Police & Crime
Commissioner, Police etc.)
Funding website - please state which one
From another local community organisation
(please put a tick in the box)
From a partner organisation
(please put a tick in the box)
Other - please state
Please note that the information provided may be subject to a Freedom of Information
request under the Freedom of Information Act 2000 (please see Grant Standard Conditions
para 32
When complete email to: