Grant Application Form s4

Grant Application Form V2 ©IH and Léonie Cowen & Assocs - 20.10.16

GRANT APPLICATION FORM

Project Name

Name of Applicant for Grant Funding

Date of Application

Amount of Grant Funding requested

If you are asking for £500 or less please see the beginning of the guidance at www.inspirehounslow.co.uk on the information to be provided.

If you are asking for more than £500 please read all of the guidance and complete the application form in full.

Please ‘Save as’ this document with a file name of: ‘Project name DDMMY’

e.g. ‘Arts4u 21116’

This file is your grant application. You should quote the reference on page one in all of your correspondence with IH and if you send a revised grant application you should amend the name by adding after the original name and date, the date of the revision, for example, “Art4u revised DDMMYY”.

Application Details

Part 1 - Basic Information

1. Name of organisation applying for grant funding.

2. Name of person making the application.

3. The applicant’s role in the applicant organisation.

4. Main address for correspondence.

5. Telephone number where you can be contacted.

6. Email address where you can be contacted.

7. Registered office of the applicant organisation.

8. Headquarters of the applicant organisation if this is different from either the address set out in question 4 or question 7.

9. Website address of the applicant organisation.

10. Legal status of the applicant organisation.

11. If the applicant organisation is a company/registered society what is your registration number?

12. Does the applicant organisation have charitable status? If so, set out details of your charity registration/number.

13. Please provide a copy of your current constitution.

Attached

14. Please summarise the applicant organisation’s main activities and where these take place.

15. If the information in your accounts is not up-to-date, please set out the names as well as the addresses of your trustees/directors.

16. How long has the applicant organisation been in existence?

17. Please provide a copy of the applicant organisation’s last audited accounts.

Attached

18. If you do not have audited accounts and/or your organisation has been in existence for less than three years, please provide recent unaudited accounts and any other financial information which you have available.

Attached

Part 2, Details about your Grant Application

19. Please describe your project and its aims including the identified outcomes and who will benefit from the project.

20. Why is the project needed?

21. Please explain why the funding is needed.

22. What are the proposed delivery dates (start and end date)?

23. Please detail the overall project budget, set out a project plan and how you would like the IH funding to be paid/structured.

24. Please detail any non IH funding including who is the funder and/or separately detail any value in kind which the applicant organisation or another funder is providing.

25. Is all additional funding which you require to deliver the project confirmed as available? If some or all of this is not yet confirmed, when do you expect to hear and what happens if it is not available?

26. How will you monitor and evaluate the success of the project and what information will you send IH to confirm that you have done this effectively?

27. Please set out how you will publicise the project and confirm you will acknowledge that you have received funding from IH on your web page and that IH may publicise the grant funding that it has given your organisation on its web page and otherwise.

28. If your application includes personal information or this could be provided at a later date please confirm you have obtained or will obtain consent to provide this information and for it to be made public (for example on your web page or that of IH or otherwise).

29. Please confirm that you have obtained all regulatory certificates, consents and any other requirements that you need to deliver the project or will have obtained these before the project starts.

Declaration and Checklist

I hereby confirm the following that:-

30. The information set out in this application form and supporting information is accurate, I am duly authorised by the applicant organisation to make this application and complete this form on the applicant organisation’s behalf, the applicant organisation is legally entitled to apply for this grant and to use the money as set out in this application.

Confirm

31. The applicant organisation understands that any money will be a grant (i.e. a gift and not a contractual entitlement).

Confirm

32. The applicant organisation understands that if any grant funding is not used as set out in this application, or as otherwise agreed by IH, IH is under no obligation to make any further payments and may recover any money paid to the applicant organisation which has not been properly used or where the applicant organisation has discontinued the project part way through.

Confirm

33. If any of the information in this application form, any attachments and/or any further information which is supplied by me or by the applicant organisation or any other third party is materially inaccurate, for whatever reason, IH is under no obligation to make any further payments and may recover any money paid to the applicant organisation.

Confirm

34. Until I fully complete this form and/or provide the supporting information which is required IH may not consider my organisation’s grant application.

Agreed

Name

Position in the applicant organisation

Date

Checklist of Supporting Information which should be attached

A letter from HMRC confirming you have charitable status (question 13).

Is this attached? Confirm

A copy of your current constitution (question 13). Is this attached? Confirm

A copy of the applicant organisation’s last audited accounts or other required information (questions 17 and 18). Is this attached? Confirm

Details of the overall project budget, project plan and proposed payment schedule (question 23). Is this attached? Confirm

Information and evidence about any non IH funding (questions 24 and 25).

Is this attached? Confirm

Anything other information which you consider is relevant. Is this attached? Confirm

N/A

Registered Office of Inspire Hounslow

3A Loveridge Mews

London NW6 2DP

Inspire Hounslow is a company limited by guarantee and is a charity

Company Registration Number, 3548669

Charity Commission, 1104413

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