<p>Small Local Groups Support Fund (under £150) Application form</p><p>Use this form to apply for £150 or less. Please read through this form carefully, then complete all sections of it, writing clearly and in black ink. Details of who’s applying</p><p>Name of Group or Network: ______Friends of the Earth Name of Proposer: ______Position in Group or Network: ______Address for correspondence: ______Telephone: (day)______(eve) ______E-mail address: ______Signature: ______Date: ______This application is endorsed by the following officer of the Group or Network Name: ______Position in Group or Network: ______Signature: ______Date: ______</p><p>Do you need a decision by a particular date? Yes No If yes, by when? ______</p><p>Why are you applying?</p><p>Why does your Group want a grant? Give a brief description of the project/ campaign/ item for which you are seeking funding. What do you hope to achieve by carrying out this work/acquiring the item?</p><p>The main purpose of this application is to: (please pick one)  run a local campaign  develop the Groups ability to campaign </p><p>What do you propose to do with the grant? </p><p>1 Give details of how the Group plans to do with this money. You may summarise any objective(s), targets, the tactics or methods that you intend to use, and the people and resources that are needed. </p><p>When do you propose to spend the grant? Give details of the timetable for this ‘ project’</p><p>How will this project benefit your Group, both now and in the future? </p><p>What external benefits will the project have? E.g. to the environment, other FOE Groups, local communities etc.</p><p>How will you measure the success or effectiveness of this project? .</p><p>How much will it cost?</p><p>Please provide a full budget summary, itemising all of the elements that are involved in delivering the project; if you have any quotes or estimates then do attach copies of them.</p><p>Description of cost item - make sure that you include everything that’s involved, ie project Estimated cost running costs as well as new resources.</p><p>2 £ £</p><p>£ £</p><p>£ £</p><p>£</p><p>Total £</p><p>How much funding are you applying for from of the Small Local Groups Support Fund? ______</p><p>If this grant will not cover the entire costs of the item/event then does the Group have enough funding to cover the balance of the costs? Yes No </p><p>If you are successful in your application we will ask you to complete an evaluation form. When will you return your evaluation form? ______</p><p>Have you included minutes or other evidence that the Group as a whole supports the application? Yes No </p><p>Please return this form to: Support Fund Manager, Activism Team, Friends of the Earth, The Printworks, 139 Clapham Road, SW9 0HP or [email protected] </p><p>3 Small Local Groups Support Fund Internal checklist</p><p>The process Date of receipt ______ Application received by Support Fund Manager Application details databased   Details databased (Date, Group, amount applied for, campaign or development Details of any other applications made in the lead, purpose of grant) by Fund Manager current financial year by this group  Details copied to appropriate other ______person(s) by Fund Manager ______ Decision reached by Fund Manager  In case of refusal this includes reasons for Application passed for assessment to doing so ______and  In case of an award this includes the ______and amount awarded, conditions that will apply and arrangements for monitoring. ______ Cheque raised by Team Leader  Letter of offer including conditions, Details of decision databased  monitoring requirements and cheque sent to Group by Fund Manager Grant agreed?  Details databased Yes No </p><p>Grant refused</p><p>Reasons for refusing grant ______Grant awarded ______Amount applied for £______Amount granted £ ______Cheque raised on ______Letter of offer with cheque sent to Group on ______</p><p>4</p>