Community Grants Form

All fields marked with an Asterix (*) must be completed. Please make sure you have read the guidance notes before completing this form.

How much funding are you applying for? Please note maximum value(*)

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What will be the impact of your project if the council can only fund part of your project?(*)

Please let us know impact

What is the start date of your project?(*)

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What is the end date of your project?(*)

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Is your organisation?(*)

A registered charity, community or voluntary groupAn arts organisationA club for older peopleFirst Tier Local Government running/commissioning a summer play scheme

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What is the name of your organisation? If you are a charity please also include your Social Enterprise Charity number.(*)

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What does your organisation do? In no more than 200 words please summarise your organisations aims and objectives(*)

0/200

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First name of person responsible for this application(*)

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Surname of person responsible for this application(*)

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Position in organisation(*)

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House number and name of street for correspondence address(*)

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Town/village(*)

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Postcode(*)

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Your daytime telephone number(*)

Please enter a valid postcode

Your evening telephone number(*)

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Your email(*)

Please let us know your email address.

Do You have any communication preferences(*)

YesNo

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If yes, please specify

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What is the total balance of your organisation's unrestricted funds, reserves or large surpluses? (The amount of funds that are surplus to any planned activities)(*)

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Please explain any unrestricted funds, reserves or large surpluses (if you have large surpluses please explain why your project can't be funded out of this)(*)

Tell us about surpluses

Explain your project in 500 words. Be specific. What you will do, how you will do it and what you would spend your community grant on?(*)

0/500

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What activities do you want us to fund? (for example 3 canoes - use separate boxes for different items) •Where capital and revenue expenditure is under £1000 one written quote/evidence of proposed expenditure must be provided with the application. •Applications over £1000 must provide three written quotes for each item over £1000 •Applications will not be considered without this information. •Please explain any assumptions you have made when calculating costs and if quotes or estimates from suppliers or experience from other projects have been used. Item 1.(*)

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Item 2 (if applicable)

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Item 3 (if applicable) and cost of item

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Item 4 and cost (if applicable)

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Upload Quotes(*)

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Breakdown of costs (*)

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Total Amount(*)

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If the project is ongoing how will it be funded in future years?(*)

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What is the total amount of funding your have already secured? If your organisation is contributing please explain. Match funding can include 'in kind' such as goods and services. Include number of volunteers and the amount of time they give(*)

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Additional funding applied for to support this project. Include details of applications where a decision is pending(*)

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Approximately how many Erewash residents will this project benefit?

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What area of Erewash will your project benefit? for example whole of Erewash, one town only? (*)

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How will your project benefit those most at risk of social and/or economic inequality and reduce barriers for example isolation caused by age, health, disability, gender or ethnicity.(*)

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In no more than 500 words describe how your project will meet the funding priorities of the Council identified within the Community Grant Policy 2020-2024(*)

0/500

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Project Evaluation: How will you ensure that your project is successful and how can/will you measure the successes? (An end of project evaluation will be required for all funding over £500. For funding awards under £500 we will require written confirmation of expenditure.) (*)

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Governance Requirements

Does your organisation have a Child Protection Policy?(*)

We have a child protection policyNot applicable

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Does your organisation have a Vulnerable Adults Policy?(*)

We have a Vulnerable Adults PolicyNot applicable

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What is your OFSTED registration number(*)

Yes, I have a numberNot applicable

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Ofstednumber

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Do all persons involved in the project have a Disclosure & Barring Service (DBS check)?(*)

Yes all staff working with children and young people or vulnerable adults have appropriate DBS checksNot applicable

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Do you have public liability insurance?(*)

yesno

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Do you have Leaders’ qualifications?(*)

yesno

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Do you have affiliation to a governing body(*)

yesno

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Do you have other insurance?(*)

yesno

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If you answered yes to any of the above, please provide further details.

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You must provide all information and meet the following criteria to be able to apply for a grant: Applications cannot be processed without evidence for all this information:

You are authorised to apply for a grant from Erewash Borough Council on behalf of your organisation
Written quote/evidence of expenditure has been provided with the application. Applications will not be considered without this information.
To verify your organisation’s bank account details you have sent with your application a blank cheque marked ‘cancelled’ or a copy of your bank statement which details the sort code, account number and name of your organisation.
You have sent with your application your most recent full set of independently verified or audited accounts. This will be required for all funding applications over £500.
You have relevant insurance in place for your project.
Should your project involve working with children or vulnerable adults, all staff have a Disclosure & Barring Service (DBS check) and have received appropriate training.
You have answered all the relevant questions in this application form.
You understand that if you make any seriously misleading statements (whether deliberate or accidental) at any stage during the application process, or knowingly withhold any information, this could make your application invalid and you could be liable to repay any funds to the council.
Your organisation meets our eligibility requirements set out in the EBC Community Grants Policy 2020-2024 and has the legal power to set up and deliver the project described in this application form
If requested, you will send us copies of your: Signed Constitution / Set of Rules or Memorandum & Articles of Association; Most recent annual report / business plan (if available); Signed Equal Opportunities Policy (if available); Signed Child Protection / Vulnerable Adults Policy (if your organisation works with or for young people / vulnerable adults).
You comply with the EBC Community Grants Policy 2020-2024 Terms and Conditions of grant.
You agree to provide EBC with an end of project evaluation report for all applications over £500 or evidence of expenditure for all projects under £500.

I have read all of the above criteria and confirm that each point is met(*)

Yes

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Please add me to the Council’s database in order that they can contact me to let me know about information that may be of interest to me such as alternative sources of grant funding.(*)

yesno

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For additional information and support please contact Erewash Borough Council’s Community Engagement Officer, email colin.handley@erewash.gov.uk or telephone 0115 907 2244 extension 3575. If you would like hard copies or alternative versions such as large print, audio or different languages, we will do our best to accommodate your request.

I live in, and, or work in the Borough of Erewash and would be interested in helping to inform and shape the Councils’ Services. I would like to be added to the Councils’ online Consultation Panel and take part in online Surveys, I understand my email address will be used for this purpose.

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