STRATEGIC FUNDING REQUEST

APPLICATION FORM FOR THE GRANT GIVING FUND

STRATEGIC FUNDING REQUEST (OVER £2,000)

Organisation Name:

Email:

Postcode:

Website address:

Contact name:

Position in organisation:

Organisation Address:

Telephone No:

Which area or community does the organisation serve? :

What is the status of the organisation? Charity, CIC, other? Charity Registration number if applicable.

Are you a registered for VAT?
yesno

Do you have a bank account in the name of your organisation? :
yesno

Please provide a copy of:

the Charity Deed, Scheme or other governing document for the organisation
information of the trustees or management board members if not included in above
the annual report if available
the last two years accounts if available

I declare that the Statements made are, to the best of my knowledge and belief, correct in every respect.

Signature of Applicant:

Date :

Income and Expenditure: (Please complete if accounts not available)

INCOME

Last Financial Year £

Funding from Public Sector bodies

Funding from other organisations

Rents earned on any owned properties

Income from other sources

This Financial Year £

Funding from Public Sector bodies

Funding from other organisations

Rents earned on any owned properties

Income from other sources

Total

EXPENDITURE

Last Financial Year £

Salaries

Training

Rent and Building Costs

Administration and governance costs (not salary)

Other costs

This Financial Year £

Salaries

Training

Rent and Building Costs

Administration and governance costs (not salary)

Other costs

TOTAL EXPENDITURE

CAPITAL AND PROPERTY

Last Financial Year £

Value of any investments

Value of any property owned by organisation
Less any mortgage or loan payments on that property.

Address 1

Address 2

Length of lease of any building where the organisation is based.

Do you have any reserves?

This Financial Year £

I declare that the Statements made are, to the best of my knowledge and belief, correct in every respect.

Signature of Applicant:

Date :

Have you applied to any other organisations for this funding? If so, please list all organisations you have applied to, including ones that have not yet decided or have rejected the application.

Name of Organisation

Date Applied

Specify Outcome: Grant/ Rejection/ Awaiting decision

If successful: Date grant received

If successful: Amount of Grant

Please continue these sections on an extra sheet if necessary:

What is the funding application for? Please give specific details about how the budget will be spent and what the project or funding aims are.

I declare that the Statements made are, to the best of my knowledge and belief, correct in every respect.

Signature of Applicant:

Date :

Can you demonstrate the need for the funding and local stakeholder support through consultation or other means?

Who will be responsible for the expenditure of the grant and/or delivery of the project?
How will the outputs of the funding be measured or demonstrated to have delivered its aims?

I declare that the Statements made are, to the best of my knowledge and belief, correct in every respect.

Signature of Applicant:

Date4 :

How will the outcomes of the grant expenditure support Chester Municipal Charity’s aims and what positive, sustainable change will result from the grant?

Have you been offered match funding from other organisations?

Any other comments.

I declare that the Statements made are, to the best of my knowledge and belief, correct in every respect.

Signature of Applicant:

Date :

The completed application and copy supporting documents should be forwarded to:
Dee Denton, Administration Officer, The Bluecoat, Upper Northgate Street, Chester, CH1 4EE
email: office@thechesterbluecoatcharity.co.uk

For further information please telephone 01244 345787

Any information submitted will be held securely and in accordance with the Charity’s data protection policy.

APPLICATION FORM FOR THE GRANT GIVING FUND