<p> FAIRLIE COMMUNITY TRUST </p><p>SSE HUNTERSTON/FAIRLIE COMMUNITY FUND</p><p>APPLICATION FORM FOR SMALL GRANT OF UP TO £250 BY INDIVIDUALS OR NOT FORMALLY CONSTITUTED GROUPS</p><p>Please read the accompanying Guidance Notes before completing each section</p><p>Section 1 – Contact Details</p><p>1a Name of individual/group</p><p>1b Contact name for application</p><p>1c Address</p><p>1d e mail address </p><p>1e Telephone daytime evening/weekend</p><p>Section 2 – About you/your group</p><p>2a If a group, how many members in the group?</p><p>2b If a group, how many members are permanent residents of Fairlie (KA29 postcode)?</p><p>Section 3 – Details of grant requested</p><p>3a In no more than 25 words describe what you wish the grant for. Please complete on separate sheet clearly marked Q 3a</p><p>3b In no more than 50 words explain how the grant will benefit you, your members, and if applicable the wider Fairlie community. Please complete on separate sheet clearly marked Q 3b</p><p>3c If you are seeking the grant for a project, event or activity, what is its total estimated cost? Make sure VAT is included as applicable.</p><p>3d Are you seeking the grant for a project, event or activity, that requires planning or other statutory consent? If so are all consents in place? Please provide copies of each consent.</p><p>1 Issue04/2014.1 3e Are you seeking the grant for a project that will take place on land or property not owned, rented or otherwise controlled by you or a member of your group? If so do you have the consent of the owner? Please provide a copy of the consent.</p><p>3f If you are seeking the grant for an event or activity, is the event a 'one off' event or an annual event which has taken place in the past year?</p><p>3g What is the total estimated cost of the project?</p><p>3h What contribution do you wish from the SSE Hunterston Community Benefit Fund?</p><p>3i If there is a shortfall how do you intend to make this up?</p><p>3j If you receive the amount requested, are you in a position to start the project/hold the event within three months, and thereafter see it to completion within 12 months?</p><p>3k When is the expected date of completion of the project or date of the event?</p><p>Section 4 – Further Information </p><p>4a If there is any further information you would like to provide in support of your application please submit on separate sheet BUT do not repeat information already given.</p><p>Section 5 – Have you included the following with the completed application form? a) If applicable a copy of all statutory consents and/or landowner agreements b) If applicable a copy of any estimate(s) or supplier quotation(s) relating to the project. c) Your response to Q 3a and Q3b and any additional information sheets.</p><p> d) If relevant to the project, a copy of the organisation's Child Protection/Vulnerable Adult Policy</p><p>Declaration</p><p>By submitting this application to Fairlie Community Trust I certify that the information given is correct. I understand that the decision made by Fairlie Community Trust/SSE with regard to the application is final.</p><p>Signed and dated</p><p>Please return completed form to</p><p>The Administrator SSE Hunterston/Fairlie Community Fund</p><p>2 Issue04/2014.1 30 Bay Street Fairlie KA29 0AL</p><p>3 Issue04/2014.1</p>