DISTRICT ~ COMMUNITY FORUM GRANT FUND t/1J County Council ,,,._J(<__ V'-1 - II /1 6 - 00 (,, APPLICATION FORM 2017/2018 Please identify the community forum you are applying to: Warwick Rural West

Kenilworth North South Rural East Rural West Warwick Leamington Leamington

Beausale, , & Wroxall Parish Council Name of applying group - Name of contact person, and postal address - Email address - Phone number Refurbishment of Phone Boxes, one in Haseley Knob Describe what you want the money for. and one in . When do you anticipate you will have Within the next 6 months spent it all?

How much money are you TOTAL COST OF PROJECT = £246 asking for, and what will you use it for? TOTAL SUM REQUESTED = £200 • If you have to pay VAT you must ITEMISED LIST OF COSTS include VAT in your total • Will you have the correct level VAT not required insurance in place {please Insurance is in place confirm if appropriate)

Describe how much of your We have £100 in 'the phone box fund' organisation's own money or resources you are putting in. {If none, please say why.)

If you have applied for other grants for this work, tell us: We have not previously applied. • how much • where from • if the grant has been awarded Purpose of previous award from community Amount If you have had any grants from any forum grant fund, and name of forum community forum in the last 12 months, please tell us what for, and how much. None The inhabitants of Haseley .Knob and Beausale, as Describe the target group that will • well as people passing through. benefit. • The phone boxes are now used for advertising local • How many people will benefit? information. We intend to give the location of the • Who do you aim to benefit? nearest Defibrillator. How will you let people know about • I your activity? ~ Which geographical area will you focus on? (e.g. a neighbourhood or parish.)

If you are going to operate from a N.A. building, please tell us where it is.

Which community forum priority or local N.A need will this grant address?

How do you know there is a need for The phone boxes have been in use for a number of the work covered by your bid? years, as points of information. • Describe the evidence you have However, they both need repainting. The doors of both got and where you got it from boxes need attention, and the Beausale phone box (e.g. survey, petition, statistical currently has a broken pane of glass. data, press cuttings, etc.)

Name any groups or agencies working We would employ a specialist to do the work. with you on this. (Solo and partnership bids are both welcomed.)

Describe how you will prove that the work has been done, and demonstrate The visual impact of the Boxes. the impact it has had. After the money is spent we will need to see: • receipts • evidence of delivery of the work Yes • numbers of people benefiting • evaluation of the work Does your group have its own bank Yes account? (This cannot be an individual's account.)

If 'No' to the above, give the name of the group or organisation that has agreed to administer the money for you

Date form submitted Cllr Supporting Warwickshire County Warwickshirm__ Councillor and Warwick District 8qd~~P. Councillor t~