Warrington Borough Council

							           Warrington Borough Council
   Community Chest Grants Application Form



Grants Panel takes place on the last Monday of every month.

All applications must be received at least one week prior to this
by post or e-mail.
Please send applications, other paperwork and enquiries to:

Grants Panel, Arts & Sports Engagement Team,
Bewsey Old School, Lockton Lane,
Warrington WA5 0BF
Tel: (01925) 444069
Email: arts@warrington.gov.uk


Criteria and Guidance notes:
Please ensure you have fully read the criteria to check your project is eligible and
fully read and refer to the guidance notes for support on completing the application.


PLEASE NOTE:

We reserve the right to reclaim your grant if it is not used for the purpose(s)
described on your application form.

Priority will be given to new applicants and community projects in vulnerable areas or
with or participants from vulnerable groups.

These grants will not cover:
 Revenue or core funding
 Funding for the same project or event year on year unless it is significantly different to
   previous years activity and shows development
 Duplicate applications to different grant strands for the same project
 Furtherance of religious activities
 Political activities
 Raising funds for other causes
 Cost of hiring venues or food / refreshment costs




                             2010/11 Application Form WBC ASET Community Chest Grants
Grant Scheme you are applying to:
     Community Chest

Name of Group / Organisation:
Address:


Telephone number:
Email address:

Type of Group: (Please pick which best describes you / your organisation)

Residents / Community Association           Charity                    
Third Sector (Voluntary) Organisation       Not for Profit Organisation 
Other (please specify)

1. Name of Project / Activity Course:



2. Brief Description of Project / Activity Course: Please continue on a separate
sheet if more space is required, no more than 2 sides of A4.




                           2010/11 Application Form WBC ASET Community Chest Grants
3. How will you measure the benefits of the Project / Activity? E.g. pre and post
questionnaires, registers, evaluation, case studies, improved skills etc.




4. Who will carry out the Project / Activity? Please provide names; attach CVs or
event information:




5. Where will your Project / Activity / Course take place? Please provide the
name and postcode of the venue where the main activities will take place:




6. When will your Project / Activity take place? Please detail start and end
dates, number of weeks / days running for, and number of hours




                           2010/11 Application Form WBC ASET Community Chest Grants
7. Please give details of the groups who will directly benefit from the project
and approximate number of individuals: ** Please note, you will be required to
provide postcode and demographic information of participants as part of your report
if you’re successful in achieving funding **

Number of Sessions:

Type of activity:

Number of people taking part

Age Group to which activity is targeted

Area of Warrington that participants will come from

Number of Volunteers involved in the project

8. How will you make sure the benefits of the project continue in the future?




9. Have you received for a grant from us before?

Yes     (If yes, please provide details below)       No     


Year: …………….               Project: ………………….               Amount: ……………

Project Overview:




Year: …………….               Project: ………………….               Amount: ……………

Project Overview:




Year: …………….               Project: ………………….               Amount: ……………

Project Overview:




                            2010/11 Application Form WBC ASET Community Chest Grants
10. Budget and amount applying for:

Income

£                  Information
e.g. £200          e.g. membership fees £5 x 40 members




                   Total Income

Expenditure

£                  Information
e.g. £200          e.g. tutor costs £20 an hour x 10 hours




                   a) Total Expenditure
                   b) Total non-eligible items (food, venue hire etc.)
                   c) Total project costs eligible for funding

11. How much are you applying for? Please note 25% match funding is required
for all funding schemes and there are maximum levels that apply – please see
guidance notes for further information

12. Bank Account Details: (Please ensure you send a copy of your most recent bank
statement when returning your form)

Name of Account:
Name of Bank:
Account No:
Sort Code:



                             2010/11 Application Form WBC ASET Community Chest Grants
Contacts for the Group: Please provide contact details for 2 people that represent
your organisation or you as an individual and can be contacted to confirm the
information supplied in this application.

Name:                                       Name:
Position:                                   Position:
Address:                                    Address:


Postcode:                                   Postcode:
Telephone:                                  Telephone:
E-mail Address:                             E-mail Address:


Please tick here if you have enclosed further information     and list documents
enclosed below:



Application Check List
   Does your budget balance and reflect the activity in the application?
   Have you included the correct bank details and a copy of a recent statement?
   Have you included policies and safeguarding documentation e.g. CRB check
   numbers, copy of Public Liability Insurance policy, safeguarding / child protection
   policy / statement as applicable?
   Have you included your equal opportunities policy / statement?

Should you be successful in receiving a grant you will be required to complete a
grant monitoring form in the future. You will be required to produce receipts /
photographs / press cuttings / e-mail information, etc. to validate your grant
application.

The person signing this application form should be a senior member of the
organisation and must be an adult aged over 18 that understands the terms of the
grant as laid out in this document and in the criteria and guidance document.

I agree to publicise that Warrington Borough Council has provided a
Community Chest Grant to the project / activity named and agree to use the
grant for the purposes outlined in this application form. If successful, I
understand that Warrington Borough Council reserve the right to reclaim this
grant if it is not used for the purpose(s) described on the application form.

SIGNED:                                         DATE:

Please direct applications, other paperwork and enquiries to:
Grants Panel, Arts & Sports Engagement Team, Bewsey Old School, Lockton Lane,
Warrington WA5 0BF          Tel: 01925 444 069 Email: arts@warrington.gov.uk

**End of application form **
                            2010/11 Application Form WBC ASET Community Chest Grants
To be completed by ASET / Grants Panel

Which WBC priorities does the Project / Activity / Training Course meet?
 Prosperous and Vibrant
 Environmentally responsible and attractive
 Safe and Strong
 Healthy and Active
 Ambitious and achieving

Please state how the Project / Activity / Course meets these priorities:




Recommendation of Panel:

Approved / Declined (please circle)

Conditions of Grant in addition to standard terms / advisory notes from panel:




                            2010/11 Application Form WBC ASET Community Chest Grants