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> Community Development Fund Application
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Community Development Fund Application
Name of Organisation/Group
*
Please describe why the group was set up in the first place
Project Title
*
Name
*
Address
*
Postcode
*
Telephone Number
*
Email Address
*
Website
*
How much money are you requesting from the Community Panel?
*
Have you applied to the fund before?
*
Yes
No
If YES, were you successful?
Yes
No
What projects did you request funds for?
Is your current application a one-off cost?
*
Yes
No
Will further money/income be required at a later date?
*
Yes
No
Is the application requesting all of the project cost?
*
Yes
No
Please give a breakdown of the total project costs. Please attach copies of quotes, Three quotes MUST be obtained if any individual item costs in excess of £500. Quotes should be inclusive of VAT.
*
Attach quotes here
Files must be less than
2 MB
.
Allowed file types:
gif jpg jpeg png pdf doc docx xls xlsx
.
Please give a breakdown of the project's income e.g. fundraising, grants etc
Attach information here
Files must be less than
2 MB
.
Allowed file types:
gif jpg jpeg png pdf doc docx xls xlsx
.
Project start date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2017
2018
2019
2020
2021
Project end date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
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20
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22
23
24
25
26
27
28
29
30
31
Year
Year
2017
2018
2019
2020
2021
Please tell us about your project
*
Is this a new or ongoing project? If ongoing, when was it set up?
*
Please tell us how many local residents you estimate will use the project. Tell us how you know this.
*
Are you confident your project is not duplicating other services in the area
*
Yes
No
Please tell us about the results of any consultation you have carried out
*
How will this benefit our tenants and the wider community?
*
What could prevent your group from successful delivery of the project? Do you foresee any difficulties such as local residents not taking part of match funding not being secured?
*
If your application is successful, how will you publicise that your project is funded by us?
*
If your application is successful what payee name should appear on the cheque?
*
Does your project involve working with children, young people (under the age of 18) or vulnerable adults?
*
Yes
No
Do all the project workers have an up to date Disclosure Barring Service check? (proof may be required)
*
Yes
No
Are there any health and Safety implications relating to this project?
*
Yes
No
If YES have you undertaken a Risk Assessment?
Yes
No
Is there appropriate Public Liability Insurance cover? (if applicable)
Yes
No
Data Protection Statement
The information requested on this form is required by Connexus Group in order to assess whether or not a Community Development Fund Application can be awarded and will be shared with members of the Community Panel. Your approval to share this information is requested; please note that if you do not give approval, we may not be able to assess your application to the Community Development Fund. Connexus Group reserves the right to publicise the award of any grants given in both internal and external publications, unless we are specifically asked not to do so. We hereby give approval for Connexus Group to share any appropriate information as stated in the terms and conditions in connection with the assessment of Community Development Fund applications.
Signature
*
Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
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Year
Year
2017
2018
2019
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2021
On behalf of (organisation)
*
Leave this field blank