PROJECT PAYMENT REQUEST FORM

							PROJECT GRANT CLAIM FORM
Project Title                                                                Project          151275.
                                                                             Registration
                                                                             Number
Contact Name                                                                 Telephone
Return Address                                                               number




Date of claim                               Period this grant claim covers


Amount requested (this grant claim)                  £


Total funding       £               Previous         £               Grant              £
committed                           payments                         remaining

Grant Claim                         First                  Interim                   Final
number                              claim                  claim                     claim
Cheque to be made payable to…

Invoice number     Brief description of service / goods          Net Amount         VAT (£)       Gross (£)
/ budget Line                                                        (£)




Total grant claim
                                                                £
                 Please include a copy of all invoices and expenditure claimed.


Declaration:                                        FOR EVOLVE EB USE ONLY
I certify that the above claim is a true record
of expenditure incurred.


Signed……………………………………………………

Print Name……………………………………………..

Date……………………

Position…………………..………………………………
Please provide a report on the progress made since your last grant claim. This
should relate to the original aims and objectives stated in your application to
Evolve EB. (You may wish to use a separate sheet for this)

Please state the main aims and objectives of your project as outlined in your application:

Aim 1……………………………………………………………………………………………………………………………………

Progress made………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………

Aim 2……………………………………………………………………………………………………………………………………

Progress made………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………

Aim 3.…………………………………………………………………………………………………………………………………..

Progress made………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………

Please indicate whether you have managed to secure any additional funding towards your project
and provide details (amount, funder name, address etc)



Please give details of any press coverage your project has received (please enclose press cuttings
etc).



Please outline your planned activities over the next period (please include any opportunities for
media coverage)




Please include any additional information you feel is suitable.




Signed _________________ Print Name ______________________                 Date ______________

Project Title                                                          Project        151275.
                                                                       Registration
                                                                       Number
                                                                       Grant Claim
                                                                       number
    Please return this form with all attachments to:

    Community Grants Officer, Evolve EB, Pegholme Mill, Wharfebank Business Centre,
    Ilkley Road, Otley, West Yorkshire, LS21 3JP