Amendments to Application Form s1

Application form for The Meads Fund at

Sussex Community Foundation

Please be careful to consider how your work addresses the criteria and demonstrate this as clearly as possible in your application. The panel will be looking for an in depth understanding and knowledge of the issues as well as creative, well informed approaches to dealing with them. We are also interested to know the reasons why you believe three years funding will help you achieve this.

Completed application forms and supporting documents should be returned to our office by 5pm on 15 September 2017.

PLEASE KEEP A COPY OF YOUR APPLICATION

Q1 Contact Details

Name of Organisation:

Address:

Post code:

Telephone number: Email:

Website:

Main contact person / Second contact person
Name
Position
Telephone number
Contact email
Best time to contact

Q2 What type of organisation are you? (please tick)

1 Registered Charity – No.: ...... 1 Community Group/Club/Society …..

1 Not for profit Company – No.: …..... 1 CIC – No.: ……………

1 Other (Please explain) ………………………………………………………………..

Q3 When did your organisation start? Please give date: ...... (dd/mm/year)

Q4 What does your organisation do? Please describe its overall aim or mission. How does this application fit into the development of your organisation and what has it done relevant to this application in the past? Applicants may describe any strategic changes they anticipate if successful in this application for funding (the text boxes expand as required).

Q5 How many people are involved in running your organisation?

a)  Management committee members ...... b) Full Time Staff ......

b)  Part Time Staff ...... d) Volunteers ......

Q6 Please describe how your organisation involves people who use the service or the community you serve in planning your work?

Q7 What is your organisation’s annual income and expenditure over the last 3 years?

1. Years ……….Income £______Expenditure £______Free Reserves £______

2. Years ……….Income £ ______Expenditure £______Free Reserves £ ______

3. Years ……….Income £ ______Expenditure £______Free Reserves £ ______

Q8 Describe your project or service Please tell us what you will do with the funding you are applying for and why you think this will be effective. Please describe what you propose for each year of the project and any strategic developments which will/may ensue.

Q9 Why is the project or service needed? Please describe the context for your work and how you can demonstrate your work will make a lasting difference to this.

Q10 What will be achieved/what are the outputs and outcomes? Please demonstrate what difference you anticipate each year and cumulatively.

Q11 How many beneficiaries do you anticipate?

Yr 1…….. Yr 2……. Yr 3…….

Q12 How will you measure the impact of your work?

Q13 Do you anticipate continuing the work after this funding has finished? What plans can you make for its sustainability?

Q14 What is the benefit to the work you propose that the funding is for 3 years?

Q15 Please provide a breakdown of the budget for the work showing how the funding from the Meads Fund would be used and indicating other revenue as appropriate (you may attach your budget separately if you prefer)

Year 1

/ Year 2 / Year 3
Total:Year 1 / Year 2: / Year 3:

Q16 Has your organisation or any of its officers been subject to any formal complaints or investigation. If yes please provide further details on a separate sheet

DECLARATION:

1.  I am authorised to make an application on behalf of the above organisation

2.  I certify that the information contained in this application is correct

3.  If the information in this application changes in any way I will inform Sussex Community Foundation

4.  I give permission for Sussex Community Foundation to record the details of my organisation electronically and to contact my organisation by phone, mail or email with information about its activities and funding opportunities

Signed: / Date:

Referee

Please give the name and contact details of someone outside of your organisation who has agreed to be an independent referee for your application.

Name: Link to group/occupation:
Address:
Postcode
Telephone: / Email:

1 A signed copy of your latest annual accounts

1 A business plan or strategy for the next 3 years

1 A signed copy of your constitution or set of rules

1 A photocopy of one bank statement from the last 3 months

1 Names and addresses of all management committee members, with cheque signatories identified.

1 Child Protection or vulnerable adult protection policy (if you are working with these groups)

1 Health and Safety Policy

1 Equal Opportunities Policy Statement

If you are creating a position please attach a job description (even if this is provisional)

Well done – you’ve finished. Good luck with your application!

SCF Application Form 15/01/2014 Page 2 of 5