"ED urham FastTrack v6 2 1"
Fast Track The Rural Development Programme for England: New LEADER Approach Application Form Applicant Organisation: Name of project: For office use only: Date received: Project reference no: RDPE measure Before you complete this form please ensure that: You have read the supporting application guidance that should have been provided to you with this form or is available at RDPE - The new LEADER approach You have completed an Expression of Interest form and it has been endorsed by your Local Action Group (LAG); Your project fits the objectives of the wider Rural Development Programme for England (RDPE). Further information is available by contacting your Local Action Group. We also advise that you familiarise yourself with the Local Development Strategy for your area available on the RDPE website or through your LAG coordinator. Before you submit this form, please ensure that: You have completed the checklist on page 2 and the form is signed by an appropriate member of your business / organisation / group (e.g. chair, vice-chair, secretary or treasurer). You have answered every question as fully as possible (failure to provide key details may delay the decision-making process). You have provided appropriate supporting documentation (e.g. letters of support, planning permission, proof of match funding). If you are completing the form electronically, all of the boxes can be expanded. If you are completing the form by hand, please firmly attach any further information you wish to include to the back of the form and clearly reference the question it relates to. We would advise that any additional information provided is as relevant to question as possible. Please return your completed form to: Louise Johnson, East Durham LEADER, Park House, Station Road, Lanchester, County Durham DH7 0EX. Email: Louise.Johnson@eastdurhamleader.org.uk Tel: 01207 529621 Further information about East Durham LEADER visit the website at www.durhamrcc.org.uk/eastdurhamleader v6.2 June 11 Page 1 Submission checklist Yes No N/A All questions answered fully Copy of signed constitution enclosed (if applicable) Copy of Health and safety policy attached Copy of Equal opportunities policy attached Confirmation of match funding provided Planning or other legal permissions and consents enclosed (if applicable) Letters of support Any annexes relating to specific information the LAG wishes to capture (eg additional outputs) Further information available from your LAG Co-ordinator. Form signed by appropriate member of business/ organisation/ group v6.2 June 11 Page 2 Section A: Your Organisation 1. Name of your organisation/group/business: 2. Registered address of the organisation/group/business: 3. Postcode: 4. Main contact: 5. Position held: 6. Contact address: 7. Postcode: 8. Telephone number: 9. E-Mail address: 10. Will the above contact be responsible for managing the project? Yes No 11. If no please can you also provide the contact details for the project manager? How would you describe your organisation? (please tick) 12. Registered charity Registration no: 13. Company limited by guarantee Registration no: 14. Company limited by shares Registration no: 15. Community interest company Registration no: 16. Unincorporated club or association 17. Public sector 18. Other (please specify) 19. Do you have a VAT number? Yes No If yes can you claim back VAT Yes No If yes, please do not include VAT VAT Number: in the finance tables in Section C v6.2 June 11 Page 3 20. Does your group have a constitution or a set of rules for conducting Yes No the business of the group? If yes, please provide a copy with this application. 21. When was your organisation/ group/ business established? 22. Has your organisation, group or business previously received public funding? Yes No If yes, please answer the following questions i) What was the funding source? (eg ERDP, LEADER+, ERDF, ESF) ii) How much was the grant? £ iii) What was it for? 23. Does your organisation have an equal opportunities policy? Yes No (if yes please attach to application) 24. Does your organisation have a health and safety policy? Yes No (if yes please attach to application) If you answered No to either question 25 or 26 above please be aware you will need to develop them if your funding bid is to be successful. v6.2 June 11 Page 4 Section B: Project Details 1. Name of project 2. Planned start date Planned end date 3. Is planning permission required? If yes, you must provide evidence that it Yes No has been granted before we can approve your project. (See www.netregs.gov.uk) 4. Please provide a description of the project. (150 words max) What are the objectives, outputs and expected outcomes of the project? Describe what actions have taken place so far. List all partners involved in the project. 5. Please describe exactly what the funding will be used for? (150 words) v6.2 June 11 Page 5 6. Why is this project needed? e.g. Scale of market demand or need for your product or service. (150 words) 7. Provide a description of how the project will be managed and delivered. (150 words). Who is responsible for the project on a daily basis? Who will be submitting claims, progress reports? Who will be responsible for document retention? Explain how you will manage the cash flow. v6.2 June 11 Page 6 Section C: Project Finances Please remember that your request for RDPE support is limited to a maximum of £14,999 under the Fast Track application process. You should provide as detailed a breakdown as possible of what your project will cost in the table provided. Please note: you can not start to incur costs prior to approval. Expenditure claimed for work already carried out before this date will be deemed as ineligible and not paid. 1. Table A: Expenditure breakdown Please use the table to describe the full costs and funding package associated with your project. If you are unable to reclaim VAT the costs provided should include VAT where applicable, otherwise the costs should exclude VAT. Capital costs 2011/12 2012/13 2013/14 Total £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 Revenue costs £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 Total project costs £0 £0 £0 £0 Do the above costs include VAT? Yes No v6.2 June 11 Page 7 2. On what basis are the costs in table A calculated? You must address each cost individually E.g. PC estimated costs based on 3 quotes. (Please continue on a separate sheet if required) Item of Expenditure Basis of cost calculation 3. Table B: Project Funding Package 2011/12 2012/13 2013/14 Total £ % of Total £ £ £ RDPE Funding 0 Approved Applied Private Sector Funding for Sources 1. 0 2. 0 3. 0 4. 0 5. 0 Total Private Sector 0 0 0 0 Other Public Sector Funding Sources 1. 0 2. 0 3. 0 4. 0 5. 0 Total Public Sector 0 0 0 0 1 Applicants Own Labour 0 In-Kind Contributions 0 Total 0 0 0 0 1 Please refer to Annex B in the supporting application guidance. Any costs prior to approval are ineligible. v6.2 June 11 Page 8 4. Will your project generate any revenue? Yes No N.B. If revenue will be generated please attach forecasts for three years to this application form. 5. Table C: RDPE LEADER Expenditure Profile Please use the table below to profile the project expenditure identified in Table A. Please note that claims will only be paid at the approved intervention rate, the profile below must therefore reflect this. Claims should be itemised on a quarterly basis. 2011/12 2012/13 2013/14 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Total Apr-Jun Jul-Sep Oct-Dec Jan- Mar Apr- Jun Jul- Sep Oct-Dec Jan- Mar Apr-Jun Jul-Sep Oct-Dec a) Total Project £0 Expenditure b) LEADER £0 funds to be claimed c) Claim rate % (b/a) % v6.2 June 11 Page 9 Section D: RDPE Milestones, Outputs and Outcomes 1. Project Milestones: Please indicate below the key milestones for your project. Milestones Description Date 2. Project Outputs: Please indicate on the table below the number of outputs your project will deliver. You will need to evidence any outputs you claim, please refer to Annex D of the supporting application guidance. Output Number to be delivered 2011/12 2012/13 2013/14 Total 2 Number of businesses supported 0 Jobs created3 0 Jobs safeguarded2 0 Individuals benefiting4 0 New tourism activities supported 0 Additional day visitors 0 Additional overnight stays 0 Farm diversification projects5 0 New products introduced 0 New techniques introduced 0 2 When reporting outputs this data will need to be broken down into micro-small/ medium/ semi-large/ other. 3 When reporting outputs this will need to be broken down into on farm/ off farm and Male<25/ Male>25/ Female<25/Female>25. 4 When reporting outputs this data will need to be broken down into Male<25/ Male 25-40/ Male>40/ Female<25/ Female 25-40/ Female>40. 5 When reporting outputs the activity for each diversification project will need to be provided. v6.2 June 11 Page 10 If training outputs will be generated by your project please fill in the table below: Training Output Number to be delivered 2011/12 2012/13 2013/14 6 Number of training days delivered Estimated number of recipients who will be: Micro-enterprises Non-profit organisations Public organisations Individual Farms Others Number of participants who complete training activity7 Number of participants who are expected to apply newly acquired skills in practice Number of training days 3. Project Outcomes: Please describe any other benefits that your project will deliver (150 words). It is important that you try to make these outcomes as measurable, achievable, realistic and specific as possible and try to include a date when the outcome will be achieved by. 6 Note 1 training day = 8 hours 7 When reporting outputs the recipients of training will need to be broken down into Individual farmers male <25/ Individual farmers male >25/ Individual farmers female <25/ Individual farmers female >25/ Others female <25/ Others female >25/ Others male <25/Others male >25 v6.2 June 11 Page 11 Section E: Sign off The form must be signed by a person in your group / organisation / business who is authorised to do so. This could be the chair person, vice chair, secretary or treasurer. Please note that as this investment from the RDPE will involve expenditure of public resources, there is public interest in how the investment is spent. In addition, the EU Regulations require us to make a certain amount of information available about who has received investment under the Rural Development Programme. Therefore the RPA will publish an annual list of all receiving financial support under the Programme, which will be available on a Government website. Details disclosed will include the name of business/ organisation, amount of funding received and the locality (usually at Parish level). Declaration and Undertaking Is your business or organisation solvent, and does it have a sound and satisfactory Yes No delivery record? If not, please provide details. This information will be treated in the strictest confidence. Has your organisation ever been requested to repay a grant? Yes No If Yes, please give details on a separate sheet of paper on the grant, the amount and details of the circumstances. This does not necessarily affect your chances of being awarded a RDPE grant. I confirm that, to the best of my knowledge and belief, all the information in this RDPE LEADER application is true and correct. I understand that the details in this application will be shared between the Local Action Group, One North East and Northumberland County Council, Durham County Council, DEFRA, the RPA and EAFRD; and that it is subject to RDPE publicity and procurement requirements should the application be successful. I agree to any disclosure or exchange of information about this application (including the content of any declaration or undertaking) which the department considers appropriate for the administration, evaluation, monitoring and publicising of the scheme(s) concerned. Signed Print name Position Date Data Protection Defra is the data controller in respect of any personal data that you provide to us. Your personal data will be protected in accordance with the Data Protection Act 1998. We will use the data: To support the application to which it relates For the administration of the Common Agricultural policy (CAP), and the Rural Development Scheme for England (RDPE) and to keep you informed of developments within schemes In relation to the production and safety of food. In relation to the management of land and other environmental controls. In relation to animal health and welfare. In relation to occupational health and welfare. When it is necessary to do so, we may also pass data to other organisations, for example: HM Revenue and Customs - for import or export purposes; Local authorities - for milk, health or cross compliance purposes; or The Environment Agency, Natural England and the Forestry Commission, for the administration of the Common Agricultural Policy. v6.2 June 11 Page 12