Application Form

EAST SUFFOLK TOWNS INITIATIVE Application Form Before completing this form please read the East Suffolk Towns Initiative Guidance carefully to ensure that your project is eligible to apply. If a question is not applicable, please say so. Failure to provide the fullest information and not submitting relevant supporting evidence may jeopardise your application. 1. ABOUT YOU 1.1 Organisation Details Name of Organisation 1.2 Contact Details – main contact for this organisation Name Position held within the organisation Address for correspondence Contact telephone Mobile number Email address 1.3 Type of your organisation – please tick Town or Parish Council Community Group Voluntary Organisation Community Interest Company Business Association Other (please give details) 1.4 What is the main purpose / function of your organisation and how is it managed? 1.5 Does your organisation have any of the following (please submit copies or a web link with the application) A Formal Constitution Yes No A Business Plan Yes No Registration Numbers: Yes No 1.6 How many people are involved in your organisation? Please count everyone involved with your organisation. Management Committees Trustees Paid Staff Volunteers Members Other (please give details) 2. ABOUT YOUR PROJECT 2.1 Please outline the project that you are seeking funding for (in no more than 500 words). Please include details on what you intend to do, how you intend to do it, who the key stakeholders are (i.e. which organisations have an interest and are involved in the project) and which town/s project covers? 2.2 How was the need for the project/activity identified and how does it align with the People and Places ‘Revitalising East Suffolk Town Centres’ research project. 2.3 Project start and end date (if applicable) Start End 2.4 Are there any other organisations involved in the project? Organisation Involvement 2.5. Is this application supported by the relevant East Suffolk District Councillor? Please note we will need to see confirmation of this e.g. letter/email of support ☐ Yes ☐ No 2.6 How do you intend to promote and publicise your project? 2.7 How do you intend to measure and monitor the outcomes of your project? 2.8 Project Sustainability – what is the longevity of the project and what will happen when the funding ends. How will its benefits be maintained and how will ongoing costs (if applicable) be met? 3. PROJECT COSTS 3.1 How much funding are you applying for? 3.2 Total Project Costs (please provide a full breakdown) Item / Activity Cost Total 3.3 If applicable, please provide any quotations that you have obtained for the required project along with this application form. Please state below your chosen quotation/s and reason/s why. 3.4 Is the project being matched funded by any other sources? ☐ Yes ☐ No If yes, please provide details below: 3.5 Has your organisation received financial support from East Suffolk Council (or Suffolk Coastal District Council / Waveney District Council) within the last three years? ☐ Yes ☐ No If yes, please provide details below: 4. DECLARATION By signing below, the information you have supplied is being collected and reviewed to allow us to process your application. By completing this form, you consent to East Suffolk using your information in this way. If you do not provide your consent, we will not be able to process this application. Your information will not be used for any other purpose unless we obtain your consent or unless permitted by law. Due to corporate retention requirements for financial information, your information will be retained for 7 years. Data will be processed and held securely and in accordance with the General Data Protection Regulation (and any updates). Further information about data protection and the full Economic Development privacy notice can be found on the East Suffolk Website: http://www.eastsuffolk.gov.uk/assets/Your-Council/Access-to-Information/Privacy-Notices/Economic- Development-and-Regeneration-Privacy-Notice.pdf To comply with General Data Protection Regulation 2018 and Data Protection Act 2018, I confirm that I have given my consent for my personal data to be used in accordance with the privacy notice above. Please tick here ☐ I agree to East Suffolk Council using the organisation’s name and a summary of the project in its own publicity materials. Please tick here ☐ Full Name Signature Date Please send your completed application with all the relevant supporting documentation either by email to [email protected] or by post to Funding Team, East Suffolk Council, East Suffolk House, Station Road, Melton, Woodbridge, Suffolk, IP12 1RT .

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