Organisations

Organisations Application

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Your Organisation

Organisation Name

Address

Postcode

Registered Charity Number (if applicable)

VAT Number (if applicable)

Applicant Details

Applicant Name

Position in Organisation

Address

Postcode

Telephone Number

Fax Number

Project Summary

Project Title

Timescale for delivery

Total Project Cost

Amount requested from the Consolidated Charity

About Your Organisation

Describe the aims, objectives and activities of your organisation

To whom is your organisation open?

Is membership restricted in any way?

Please provide details of membership fees and/or subscriptions

What other similar organisations operate in the Charity’s area of benefit, and what do you offer that they do not?

If your organisation did not exist what would be the effect in the area?

About Your Project or Activity

Please describe the project or activity for which you require assistance and how it will benefit the public, ie. what will the project do... what evidence do you have that the project is needed... who and how many people will benefit... how will it be delivered... how will it be managed, etc? Please note: It is current policy not to fund salaries

How will you measure the outcomes to see if the project is successful in meeting its objectives?

If this project is unsuccessful or does not proceed what will be the effect on your organisation and on the residents in the area?

Financial Details

Total Project Costs

Please give a precise breakdown of all of the costs of the project eg. equipment, hire of facilities, extra staff, other professional costs, advertising, etc. (This should add up to the total cost of the project in Section 3)

Amount of Grant Requested

How much are you requesting from the Consolidated Charity and what would you intend to spend this sum on? (This should add up to the amount requested in Section 3)

Other Sources of Finance

Please provide a breakdown of all applications for funding from other sources

Your Organisation's Own Financial Contribution

Please indicate the maximum financial contribution that your own organisation would be willing or able to make to this project and explain why you are asking for financial assistance from the Consolidated Charity

Other Inputs

Please give details of any non-financial contributions including volunteer's time you expect to receive towards this project

When you have completed the application please arrange for the Chairman or Chief Executive of your organisation to sign this declaration.

I confirm that this application has been approved by my organisation's board or managing committee. To the best of my knowledge the information provided on this application form is correct. If the Consolidated Charity of Burton upon Trent agrees to make a grant this will be used exclusively for the purpose(s) described in the application.

I agree to the Consolidated Charity making any enquiries in connection with this application.

I agree to the above terms

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