Hastings and Rother Reducing Health Inequalities Fund

Grant Application Hastings and Rother Reducing Health Inequalities Fund NHS Hastings and Rother Clinical Commissioning Group working with Artswork, Hastings Voluntary Action, Rother Voluntary Action, and East Sussex County Council are offering grants of up to £1,000 (Fasttrack) and £10,000 (Standard) to voluntary and community groups to reduce health inequalities. The Fund wishes to support projects that aim to:  Encourage and support people to make healthier lifestyle choices  Help people look after their own health better  Improve access to local healthcare and/or other support services that will benefit health  Address the wider social determinants of health The fund will only accept applications that benefit the residents living in the electoral wards listed in Q23. The reason for this is to direct support to the most disadvantaged and marginalised communities and those most at risk of poor health. The fund is supported with additional investment from Artswork, the Bridge Organisation for the South East. All projects where the principle activity is arts/ cultural should in addition aim to: • Ensure more children and young people have access to and benefit from high quality cultural education by achieving Arts Award • Ensure more settings, where eligible, achieve Artsmark Please refer to the Hastings and Rother Reducing Health Inequalities Fund guidance notes to help you complete this form. If you would like support and advice about your project proposal please contact Hastings Voluntary Action (HVA) or Rother Voluntary Action (RVA). Please send the completed grant application (along with supporting documents) to: [email protected] The closing date for Standard grant applications is 5pm Friday 7th July 2017.

Section 1 – Your group or organisation

Q 1 Name Q 5 Email Address

Q 2 Address Q 6 Website address

Q 7 Twitter name

Q 3 Postcode Q 8 Facebook name

Q 4 Telephone Number Q 9 When did your group/organisation begin?

1 Q10 What type of group or organisation are you?

 Community Group ______

 Charity – No. ______

 Not for profit Company – No. ______

 CIC - No. ______MAIN CONTACT DETAILS:  Other (Please specify) Q14 Name

Q11 Is your group part of a larger regional Q15 Role in group or organisation or national organisation?

 Yes No Q16 Daytime telephone number Q12 Has your group or organisation received funding in the last year? Q17 Mobile phone number  No  Yes Q18 Email address If yes, please give details below of any funding received in the last financial year. Q19 Address Funder Amount £ £ £ £ £ Q20 Postcode

Q13 What does your organisation do? Section 2 – Your project Q21 This grant is:

2  For new work

 To build on existing work

Q22 Please enter the start and end dates for the activities this grant will fund. Start date MONTH YEAR

End date

3 MONTH YEAR

4 Q23 In which electoral ward will the project take place?

Bexhill Central (Rother DC)

 Bexhill Sidley (Rother DC) Q24b Projects where the principle activity is arts/ cultural will in addition aim to: Eastern Rother (Rother DC)  Ensure more children and young people Baird (Hastings BC) have access to and benefit from high quality cultural education by achieving Arts Braybrooke (Hastings BC) Award

Castle (Hastings BC)  Ensure more settings, where eligible, achieve Artsmark Central St. Leonards (Hastings BC) Section 3 – Who will benefit? Gensing (Hastings BC) Q25 How many people do you think will benefit from your project? Hollington (Hastings BC)

Maze Hill (Hastings BC) Q26 Which groups of people will benefit from your project? Old Hastings (Hastings BC)  Children and young people Ore (Hastings BC)  Adults Tressell (Hastings BC)  Older people Wishing Tree (Hastings BC)  People with mental health issues

Q24a The project this grant will fund will:  People with learning disabilities

 Encourage and support people to  People with physical disabilities make healthier lifestyle choices  People with a long term condition  Help people look after their own health better  People with a terminal illness  Improve access to local healthcare People on low incomes and other support services that will  benefit health  Homeless people  Address the wider social determinants of health  Black, minority or ethnic groups  Lesbian, Gay, Bi-sexual people

 Gender or Transgender people Section 4 – Your Project Q31 Please describe your project (For  Other Fasttrack applications please use up to 150 words; for Standard up to 400 words) Q27 From the list above (Q26), what group will benefit the most from your project?

Q28 Which age groups will benefit from your project?

 0 – 4 Early years

 5 – 12 Children

 13 - 18 Young people

 19 - 25 Young adults

 25 - 64 Adults

 65+ Older people

Q29 How many people from the age groups will benefit from your project? 0 – 4 Early years _____

5 – 12 Children _____

13 - 18 Young people _____

19 - 25 Young Adults _____

25 - 64 Adults _____

65+ Older people _____

Q30 From the list above, what age group will benefit the most from your project? Q32 How will you know if your project is helping people or is successful? (For Fasttrack applications please use up to 150 words; for Standard up to 400 words)

Q33 How will you measure the benefit or success of your project? (For Fasttrack applications please use up to 150 words; for Standard up to 400 words)

Section 5 – Project budget Q35 How much money are you applying for?

Q36 Please use the space below to show what you will spend the money on. Activity

Amount

Q34 Please tell us of your plans to continue this project after the funding is finished (You do not need to answer this question if you are applying for Fasttrack; for Standard applications please up to 400 words)

Thank you for completing the application. Please ensure you have included (where necessary):  A signed copy of your latest annual Address: accounts  A signed copy of your constitution or set of rules Postcode  Copies of written estimates or catalogue Telephone: Email: pages, if you are applying for a grant to purchase equipment. Signed:  A photocopy of one bank statement from the last 3 months  Names and addresses of all management committee members, with cheque signatories identified.

Depending on the nature of your project or activity, we would expect you to send us additional documents if relevant:  Child Protection or vulnerable adult protection policy (if you are working with these groups)  Health and Safety Policy  Equal Opportunities Policy Statement  If you are a CIC please include your CIC 34 report 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 East Sussex County Council 4. I give permission for East Sussex County Council 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:

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. Note: Your referee must sign this form

Name: Link to group/occupation: