Community Chest Application Form This application is for projects requesting funding of up to £500. Please refer to the guidance notes before completing this form. Contact Lisa Bedford (Community Regeneration Officer) for advice and support in completing this form. Tel: 01746 713209 / 07794394031 or e-mail lisa.bedford@shropshire.gov.uk 1. Name of project
2. Name of the Organisation:
3. Contact Details: Name: Address:
Telephone: E-mail: 4. Does your organisation have a governing document e.g. constitution, set of rules? Yes No 5. Does your organisation have a bank account? Yes No 6. Please indicate in which parish your project will be carried out Boraston Coreley Farlow & Oreton Kinlet Neen Savage Wheathill Burford Cleobury Mortimer Hopton Wafers Milson & Neen Sollars Stottesdon & Sidbury
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7. Please give a brief description of your project.
8. Project start date 10. Total cost of project: £
9. Project end date
11. Amount of funding requested from community chest scheme totalling no more than 50% of your total costs up to a maximum of £500 £ 12. Please detail the estimated total costs of the project? Itemised Costs (e.g. equipment, publicity, training etc) Amount (£)
Total
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13. Please detail below how will you fund your total project costs? Please indicate if the funding sources are confirmed (C) or unconfirmed (U). (This can include volunteer time valued at £7.75 per hour, and any other fundraising activities or grants) Funding Sources Cleobury Country Community Chest Amount (£) C/U
Total 14. Please explain why there is a need for this project
15. Please give details of what your project hopes to achieve, and how it contributes to the Cleobury Country vision:
“Linking communities who live and work together to…Promote and celebrate the rural heritage of our special landscape, provide fresh experiences and new opportunities for all, and to develop and strengthen the Cleobury Country identity and lifestyle.”
Provide fresh experiences and new opportunities for all
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Declaration by the applicant:
“I declare that to the best of my knowledge the information given on this application form and any supporting material is correct”
Signature of applicant Print Name Position in organisation Date Organisation name cheque should be made out to if funding is agreed
Completed application forms can be either submitted to the Cleobury Country Ltd at Market Hall in Cleobury Mortimer or to: Lisa Bedford, Shropshire Council, Westgate, Bridgnorth, WV16 5AA. Grant applications will only be considered on a quarterly basis. The deadlines and decision dates are: Application Deadline Decision date th th 11 September 2009 12 October 2009 th 4 December 2009 13th January 2010 15th February 2010 25th March 2010 Funding for this grant scheme has been provided by Shropshire Council through the Cleobury and Rural Local Joint Committee.
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