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3 Citywide Grant Application From July 2012 by DIxXp3

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									CITY GRANT FUNDING



Application Form
_______________________________________________________________

Checklist

Name …………………………………………………………………………………..

All of the items mentioned below must be included when you submit an application to
the grant scheme.
                                                                           

Grant application form (please ensure that all sections are completed)

Business Plan including Cash Flow Forecast and Personal Survival
Budget

Reference from a Business Advisor/ Enterprise Coach
(please see section 5)

Quotations or proforma invoices for items requested on your application
Please list below:
1.
2.
3.
4.
5.

I have not requested funding for an ineligible items as per the guidance
notes.


INCOMPLETE APPLICATIONS WILL NOT BE
PUT TO THE GRANT PANEL.
Completed applications must be received by 5pm on the Friday before the grant
panel. The grant panel meets on the last Friday of each month. Applications after
this date will go to the next panel meeting.




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SECTION 1 – YOUR DETAILS

1. Name of individuals

2. Position held in the business:

3. Name of Company

4. Contact address,
Including postcode




5. Phone Number


6. E-Mail

7. Are you:

Unemployed                Employed                  Self Employed

8. Please tick the box which best reflects the ethnic origin and age range of the
business owner.

White British              White Irish           White Other


      Indian             Bangladeshi                  Pakistani


Other Asian background              Other Black background


Black African               Black Caribbean          Chinese


Other ethnic group              Prefer not to say


9. Date of Birth

10. National Insurance Number



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SECTION 2 – YOUR IDEA

11. Have you attended the Self Employment Awareness course?
      Yes          No

  If yes, please give dates.




12. Anticipated Start Date? (DATE)


  (Please note if your business has already started to trade then you are not
                             eligible for the grant)

13. What are the main aims and activities of your business?




14. Have you received European or national funding in the past or are you currently
in receipt? If so, please provide details and dates




15. Please explain, as clearly as you can, what the grant will be used for (detailed
description of activity).




16. Please give examples of how, and in what way the business will benefit from the
project i.e. what outcomes do you expect to achieve?




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SECTION 3 – GRANT DETAILS

17. Tell us how much money you need for your project and give a breakdown of
what the money is for (include VAT where it applies) Please be as specific as
possible.

Item/ Activity                                                       Amount (£)




18. Total amount requested

         (Maximum Grant of £1500 - 50% for Employed Clients & 100% for
                             unemployed clients)

SECTION 4 – CERTIFICATION

I confirm that the information given on this form is correct. I understand that the
Citywide Grant is funding of last resort and I am unable to secure funds from any
other source.

Signed


Date


Full Name


SECTION 5 – REVIEWED

This section needs to be completed by a BI business advisor or a Enterprise Coach
as a reference for your application.

Full Name


Job Title


Organisation

Email                                            Tel. Number


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Statement

              Statement – I have reviewed this application for the above grant and
              believe it to be accurate/complete and ready for the panel to consider.




Signature


Date




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