Aberdeenshire Council

							                                         Aberdeenshire Council
                            Third Sector Application for Social Work Funding
1.    Organisation:

      Organisation Name:                                            Contact Person:
      Address:                                                      Position:
                                                                    Telephone:
                                                                    Email Address:
                                                                    Web Site Address:
      Post Code:                                                    Project Name:

2.    How much funding are you seeking from Aberdeenshire Council?                £

3.    What percentage of the total project costs will be covered by this                                          %
      funding?

4.    What geographic area(s) of Aberdeenshire does this service cover?

5.    Brief description of what the funding is for:




6.    Summarise the purpose of your organisation, group, service, project or activity:




7.    Describe the difference your service, project or activity will make to your local area or community:




8.    Describe how your organisation contributes to the council’s strategic priorities and Single Outcome
      Agreement and explain how it meets these objectives: (See guidance notes for links to these documents)




9.   Organisation’s Status: (Tick all that apply)

     A Constituted Group?                   A Registered Charity?               A Company Limited by Guarantee?


     Charity Number:

     Registration Address:




     VAT Registered?                                           VAT Registration Number:

     VAT Registration Address:                                                  Other type of
                                                                                Organisation
                                                                                (please
                                                                                explain):


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10.   Please provide the names of position holders in your organisation:
      Chairman:                                               Other:

      Secretary:

      Treasurer:


11.   How many staff does your organisation employ on this project?           Full Time
                                                                              Part Time


12.   How many volunteers are involved with this project?


13.   How many INDIVIDUALS in Aberdeenshire will benefit from your service,
      project or activity?



14.   How many GROUPS will benefit from your service, project or activity?




15.    Please indicate the age groups of the individuals that will benefit:


         0-5             6-12        13-18        19-25            25-54            55-64                65+


16.    Please state which client group(s) will benefit:


Mental Health                   Young Persons       Older People                 Children                      Homeless


People with Addictions          Dementia            Learning Disabilities        Physical Disabilities         Other


17.   Please feel free to supply any other information in support of your application?




18.   What is the consequence of this funding application being unsuccessful?




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19.     Financial Profile

                                               2009/2010   2010/2011   2010/2011   2011/2012

                                                (Actual    (Current    (Forecast    (Budget
                                                Spend)       Year      Proposed)   Proposed)
                                                           Budget)


INCOME


GRANTS – Please list all funding applied for
and the outcome of any grant applications
G = Granted
NG = Not Granted
P     = Pending

DONATIONS


FUNDRAISING


FEES


OTHER (Please Specify)


TOTAL INCOME


EXPENDITURE


STAFF COSTS

PAYROLL

TRAVEL & SUBSISTENCE

TRAINING


VOLUNTEER COSTS

TRAVEL & SUBSISTENCE

TRAINING

PREMISES COSTS

HEAT & LIGHT

RENT & RATES

INSURANCE



                                                  3
OTHER (Please Specify)


MANAGEMENT COSTS


MANAGEMENT EXPENSES

AUDIT

OTHER COSTS


PUBLICITY

OFFICE EXPENSES (Postage, Telephone,
Stationery)

OTHER (Please specify below)


TOTAL EXPENDITURE


SUPLUS/(DEFICIT)




20.   Your Bank details – all fields are compulsory:


      Bank/Building Society:                                    Sort Code:

      Address:                                                  Account Number:

                                                                Signatory Name (1):

                                                                Signatory Name (2):



      Post Code:


21.   Other Financial Information

      Please feel free to add any additional financial information in support of your application:




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Declaration

Should Aberdeenshire Council award funding you will be required to sign a form of agreement
which will contain conditions relating to the funding. One of these conditions is that you
confirm that the information supplied in this form is, to your best knowledge and belief, true
and correct and that you will inform the council if there is any change in this information. In the
event that this condition is breached then the council may terminate the agreement and
require all or partial repayment of the funding.

Applicant’s Statement

I confirm that all information provided on this application, and in any material submitted in
support of it, is truthful and accurate. I undertake to inform Aberdeenshire Council fully and
immediately if any changes in circumstances require the application or the supporting material
to be amended.

Signature: ………………………………………….…………………..

Name:       …………………………………………………….………..

Position:   ………………………………………………………………

Date:       ……………………………………………………….. …….




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