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									Community Buildings Programme
Application form

Welcome to the Community Buildings programme.

You can also get this form in Braille, on audiotape, on disc or in
large print by calling us on 0845 4 10 20 30 (textphone 0845 602
1659, this is for those with hearing impairment).

Before completing your application, please make sure you have read the guidance notes. These will help you
fill in the form. Please write clearly in black ink or type
Please send your completed application form by 30 April 2007 to:

Community Buildings
Big Lottery Fund
Edmund House
8th Floor
12-22 Newhall St
B3 3NL

If you have any queries about the application form or process, please contact us on the
numbers above, or email us at

Section 1: Organisation details
1.1      Organisation name
What is the legal name of your organisation (as shown in your governing document)?
Kingston Parish Council

 Please note that commercialy sensitive information and confidential information has been

1.2      Organisation address
What is your organisation‟s registered address, including postcode?
David Jarman, Clerk to Kingston Parish Council

 Phone number 1 (or textphone)
 Phone number 2 (or textphone)
 Fax number (if applicable)
 Email address (if applicable)
 Web address (if applicable)

1.3      Related organisation
If you are a branch of, or related to, a larger organisation, tell us who they are, as they may
have some legal responsibility if we award you a grant. If you are a church-based faith
organisation, please check the table in the guidance notes.

      Tick here to confirm that your parent organisation knows about your application for a grant.

1.4      Main contact details for the project
Fill in the following details about the person in your organisation who will be the main
contact for your application. We will contact this person to discuss the application in more
detail. They must be available to talk about your project and organisation.
Name of contact
 Title Cllr     Forenames (in full)        Jacqueline Rosemary
 Surname                                   Rowland
 Position or job title                     Chairman
 Date of birth
 Address for correspondence, including postcode (leave blank if the same as the
 organisation‟s registered address).
 Correspondence to the Clerk, as above.

 Phone number (or textphone)
 Alternative phone number (or
 textphone) if applicable
 Fax number (if applicable)
 Email address (if applicable)

If the address for correspondence is different from the organisation‟s registered address,
please tell us why.

Please tell us if we should be aware of any particular communication needs your main
contact has. This might include textphone, sign language, large print, audiotape, Braille or a
community language.

1.5     Organisation type
What sector does your organisation fit into?

Public sector

Private sector

Voluntary and community sector

If you are an unincorporated association and not registered at the Charity Commission,
send us your governing document (constitution or set of rules) unless you are a parish

1.6     Reference or registration numbers
Does your organisation have a charity, company or other reference or registration number?
If so, please write it below.

 Charity number                                    HMRC charitable status

 Company number                                    and not
                                                   registered as
                                                   a charity

If you are an unincorporated association and not registered at the Charity Commission,
send us your governing document (constitution or set of rules or trust deed).
1.7       Your organisation’s bank account
All organisations that receive a grant from us must have a bank or building society account
in the name of the organisation as shown in your governing document. Cheques and other
withdrawals must be signed by at least two people who are not related to each other.
Please send an original copy of your most recent bank or building society statement with
this application form or agree to arrange this if we give you a grant (we will return this to
Do you meet this requirement?
Yes              No      (but we will put this in place if we are awarded a grant)

1.8       Your organisation’s accounts
All organisations that receive a grant from us must produce accounts. You must include a
copy of your most recent approved accounts, signed and dated by your chair, secretary or
treasurer and by your auditor or independent examiner where appropriate. The accounts
you send us should not be more than 12 months old. However, we realise that this can be
difficult if your organisation‟s financial year-end coincides with the period in which you are
sending us your application. If this is the case, send us your previous accounts and a copy
of your most recent management accounts.
If you are a parish council, we do not need you to send us your accounts at this stage,
however we may ask to see your financial records when we assess your application.

Please tell us whether you have been awarded a lottery grant before:
Yes              No
If „Yes‟, please provide us with some more information (when the grant was awarded, which distributor it was
from, what the money was for).
    In 2006 a successful bid was made to Awards For All for a Youth Shelter to provide an
    identified need for a dedicated teenager meeting place. Whilst the application was
    being processed, a safety inspection of an old nearby building was made which resulted
    in its immediate closure. This action deprives users of essential facilities and alternative
    options were explored. Resultant consultations clearly showed that the teenagers felt
    their needs would best be met by having external seating and other facilities in the
    proposed new building. The grant was, therefore, returned with thanks.

Section 2: About your project
2.1    Project name (in no more than 10 words)

 Kingston Pavilion

2.2    Project summary
Briefly describe your project and what you plan to do (in no more than 300 words).
 An existing „Pavilion‟ on the Village Green (an old apple store erected after the first World
 War) has done good service, but had to be closed because it is structurally unsound and
 does not meet Health and Safety and Fire Regulations. This building has been well used
 and replacement facilities are urgently needed.

 For safety reasons, this old building needs to be demolished as soon as possible and
 replaced with a new community and sports pavilion. New facilities are urgently needed in
 order that existing sports and village activities can continue. Additionally, widespread
 consultation (Village Action Plan, questionnaires and direct contact with local people) has
 shown a clear need for development of other vital village activities that will both enhance
 and strengthen community cohesion.

 It is proposed to build a new Community Building to accommodate present and future
 needs which currently include football, cricket, tennis, croquet, Village Downland Races
 and Barbecues. A clear need has also been identified for all age groups (including
 mothers and toddlers, teenagers, the elderly, disabled) for facilities as well as sporting
 activities, e.g. Clubs for mothers and toddlers, carers of young children, elderly people,
 teenagers, the disabled, library, computer skills, gardening. This purpose-built facility will
 provide the opportunity to develop new inter community and trans-generational

 Capital works will comprise a community room, kitchen, 3 changing rooms, 3 showers, 3
 toilets (male, female and disabled, the latter doubling as referees changing room),
 hearing loop, visual aids and disabled access, small office space, storage, covered
 veranda with permanent seating and hard wet weather access and a cycle rack. The
 building will be designed to be as energy efficient and eco friendly as possible.

2.3    Project location
In the table below tell us where your project will be delivered (that is, where the project
activities will take place) and what its postcode(s) is/are.
                                                                 Location        Percentage
                                                                 Postcode        per location*
 Citizens Advice Bureau, Enfield                                N15 4RY              25%

 St. Pancras Green, Kingston near Lewes, E. Sussex              BN7 3LW             100%

*If the project is only going to be delivered in one place write 100%

2.4 Site ownership
Tick the boxes to confirm that:

you hold a freehold or leasehold in the land and/or buildings


you will use part of the grant to buy a freehold or
leasehold interest in the land and/or buildings


you are a church based faith organisation and another
member of the family of organisations that make up your faith
holds the title to the land and/or buildings

2.5 Planning information
Please tick the appropriate box:

Planning Permission is not required


Planning permission is required but has not been applied for yet


Planning Permission is required and has been approved


The works will involve Church of England consecrated ground

2.6      Project beneficiaries
Tell us about the people and organisations that will mostly benefit from your project.
 Current beneficiaries consist of users from both within Kingston Parish (including Church
 Parochial Parish) and from 7 nearby villages and towns whose children have local
 connections and/or use the Village Green for outside sports/play and /or whole village
 events.Organisations who will benefit will therefore, include teenager and youth groups,
 the elderly, mothers and infants and toddlers groups, carers of young children and the
 disabled in addition to the football, croquet, netball, cricket, tennis clubs. Future
 beneficiaries will include multiple groups already identified by consultations and
 The whole community, including those formerly excluded by the lack of facilities
 accessible to the disabled, will benefit from the covered seating, and the availability of the
 How many people do you expect to benefit directly from
 your project?
 How many organisations do you expect to benefit directly
 from your project?

2.7    Project need
What is the need for your project?
 A suitably equipped and sited building is urgently needed so that the village green can
 continue to be used for sports fixtures and village activities, e.g. football (100 under 16s,
 plus supporters and visiting clubs), cricket club (20 children plus supporters and visiting
 clubs), tennis (231 members), and croquet tournaments, Village Downland races (90
 entrants and supporters), stoolball and village barbeques (150+). Other pressing needs
 include a wide range of facilities for the disabled, elderly, carers of young children and
 mothers and toddlers groups, and teenagers.

 In particular, we need a meeting place, which is readily available for the whole community
 to meet informally or for a particular purpose. Ideally, this would include a meeting room
 with computer and visual aids, toilets, changing rooms and showers, adequately
 equipped kitchen, a village emergency and first aid point, and adequate storage space.
 We also need to address the needs identified in our Village Plan questionnaire, e.g.
 coffee mornings, community shop, visiting Post Office, NCT, community library, medical
 facility, information point, arts and crafts, Golden Age Club, self-defence classes and a
 range of other activities. In particular, we need to provide the covered seating area for

 Although Kingston has a Village Hall, this is rarely available because it caters for both
 large groups and the pre-school. It is over ¼ mile away from the Village Green. There are
 no shops, post office, medical facilities, information point, library or computer facilities in
 the village. The need for a meeting place for teenagers was clearly identified by a
 questionnaire and direct consultations in 2005.
How have you identified that need?
 Public meetings, direct discussions with group leaders, newsletters, questionnaires and
 individual village groups, have identified the need. In particular, the preparation of
 Kingston Village Plan has stimulated interest in village activities and the Kingston Parish
 Action Plan Steering Group has played a leading part in collecting and disseminating

 In 2006 this Steering Group arranged for children from the local school to build a model
 of Kingston village and people were asked to flag suggestions for perceived needs in the
 village. This exercise really involved the whole village and provided an informed basis
 for the production of the questionnaire which followed (however, in this application we
 have purposely omitted the request for a “jail for annoying brothers”!). There was an
 excellent response to this questionnaire and the findings will provide a firm base for on
 going service provision.

Who are the main partners and stakeholders and in what ways do you work with them?
 The current main stakeholders are the users of the old apple store (Pavilion) and Green.
 These users include football, cricket, tennis, netball and croquet clubs, Village events and
 participants in Downland Race and Village barbecues. Future stakeholders will be those
 identified in the village plan (teenagers and youth groups, mother and toddlers groups,
 the elderly, carers of young children and the disabled). The whole village owns and uses
 the Green, and so collectively is a stakeholder.

 The Parish Council is a stakeholder as owner of the Green on behalf of the village, and
 representative and responsible to the village.

 The working relationship is developing in step with the Village Action Plan. Previous links
 could be seen as non co-ordinated. We are now working towards the 'pyramid structure'
 (attached), which will include the proposed management trust.

 The management trust will be established following legal advice and comprehensive
 discussions with stakeholders. This trust will develop strategic and business plans to
 manage the building and encourage development of village networks and relationships
 which have already been started on the lines of the attached pyramid.

 We have also worked with Action in Rural Sussex, Lewes District Council, the Sussex
 Association of Town and Parish Councils, Parishes of the Lower Ouse, and the local
 schools to develop our project.

2.8   Project outcomes
Briefly describe what difference your project will make by listing up to six proposed outcomes.
       Broader access to and greater use of existing services

 2.    Greater number and wider range of new services;

 3.    Improved skills, knowledge and capacity to meet community needs;

 4.    Increased participation by the community in the decisions that affect their lives;

 5.    Improved community relationships and networks
       Premises that use less energy, cause less pollution, create less waste and
       contribute less to climate change
How will your proposed project outcomes help achieve the outcomes of our Community
Buildings programme?

1. Broader access to and greater use of existing services: The provision of a new
purpose-built building will enable current use of the Village Green to continue. Without
this facility, most activities cannot continue and use of the tennis courts will fall with
consequent loss of revenue. Additionally, dedicated facilities will attract new members
because essential hygiene, social and educational needs will be met. Disabled people
will for the first time have access. More people will be able to access village groups such
as the mother and toddler, children‟s drama group, play reading group, yoga classes and
community shop, which currently struggle to operate in private houses with very limited

2. Greater number and wider range of new services: The proposed facilities will enable
new services (already identified) to be introduced and the modern facilities accessible to
all (including disabled) will support new community-orientated groups. In particular,
sheltered seating will respond to an identified need and be an extension to the indoor
community meeting room especially for teenagers.

3. Improved skills, knowledge and capacity to meet community needs: Provision of new
services will stimulate learning expectations in our rural community. This is an exciting
outcome and will envelope both traditional skills and modern technology to meet our
community‟s identified needs. In particular, computer skills are fast become a necessity in
this modern age and many of our older people would benefit from computer workshops to
develop this skill. An equally important factor is the provision of a dedicated building
where all age groups can meet and exchange ideas, knowledge, skills and interests.

4. Increased participation by the community in the decisions that affect their lives: The
pyramid on attached illustrates how the proposed management of our project will directly
increase our community‟s participation in decisions affecting their lives. This illustration
reflects the progress that has been made by the production of our draft village plan. The
draft plan has provided a framework for future developments: we now need to „deliver
the goods‟. The Steering Group was very disappointed to find that the old Pavilion had to
be closed but they soon rallied and took a positive decision to consider alternatives. This
they did by direct liaison with the community and identified the need for a new purpose-
built building. Kingston Parish Council wishes to fulfil that expectation.

5.      Improved community relationships and networks: Improvements to community
relationships and networks are being developed in line with the Village Plan. Responding
to the identified needs of the village will further this aim. Representatives from the Village
and Groups that use the building will be members of the Management Trust. (Please see
the Pyramid structure – lines of communication will flow between each tier). Facilities that
provide a focal point for informal meetings and accommodate the development of village
groups will also further this outcome. Inter community relationships are strengthened
through their participation in the groups and activities on the Green.

6.     Premises that use less energy, cause less pollution, create less waste and
contribute less to climate change:     The proposed building will be designed to be both
as energy efficient and eco friendly as possible. The proposed local facility will reduce
the need to travel for services and activities that can be provided locally in the new
community building, and sports which can only continue in the village with a pavilion.
Additionally, the village have asked that a sustainable transport policy be adopted. In
response to this, it is proposed to have a cycle rack and no extra car parks and a strong
policy of promoting minimal car use. The combined effect will be to reduce overall
emissions associated with the use of the building and Green.

Section 3: Achieving your outcomes and delivering your project
3.1 Options appraisal
a) Describe the options for delivering your project and the reason you chose this option to
meet your need and bring about your proposed outcomes.

 A. Demolish the existing building and restore the area to green. Without a community
    building all sporting and village activity would cease, and community life would be
    much diminished.

 B. Use the Village Hall: It has a full, busy and regular timetable, being used daily by the
    pre-school, and so is unavailable to many groups. It is too far from the Green to be
    used for the sports, has no suitable facilities and is unsuitable for small groups,
    (very large room and expensive to heat). The building has been extended to
    capacity, and cannot be adapted if it is to continue to meet the needs of its present

 C. Repair and improve this 80 year old building (originally an apple packing store) to
    make it sound, and meet current health, safety and fire regulations, and our
    obligations under the Disability Discrimination Act. Investigations revealed that it
    would not be feasible to do this, given the nature and condition of the structure.

 D. A prefabricated building, which would be cheaper. These lack the flexibility to meet
    design requirements in this sensitive location in Kingston Conservation Area in the
    heart of the South Downs AONB, whilst accomodating our identified needs. We are
    advised that these cannot be adapted to meet changing needs in the future at
    realistic cost. We expect the building to be well used; therefore a very robust
    building will be necessary.

 E. Carbon neutral building made of indigenous materials and built by the community
    with professional help: Research into successful local projects identified this as an
    option that would achieve many of our outcomes. We reluctantly rejected this option,
    as most able bodied villagers work such long hours they are unable to help.

 F. Our chosen option is a high quality well designed energy efficient and energy saving
    building with low outgoings and maintenance costs, designed to enhance this
    sensitive location and accommodate all facilities identified through consultation. This
    will ensure financial viability as it will have low overheads and will attract rental
    income. It will be sufficiently robust and vandal proof to minimise the risk of
    malicious or careless damage. It will reduce the need to travel to remote locations
    for sports and other activities, and encourage children to participate in sport and
    village life. It will have a long lifespan, and be capable of being adapted to meet
    changing needs well into the future.

b) Explain what methods you will use to measure and track whether the outcomes are
being achieved.

 1. The Management Trust will be representative of stakeholders, and be responsible for
 monitoring which groups and organisations use the building and for what purpose, and
 for gathering feedback from users.
 2. The Trust will be responsible for monitoring the success of the transport policy.
 3. Consultations, questionnaires, village events and regular Parish Action Plan updates
 will monitor general satisfaction, identifying which unmet or changing needs.
 4. The Parish Council will receive reports from the Trust, the Action Plan Steering Group,
 and directly from villagers at Parish and Parish Council meetings.
 5. The level of use, number of groups active in the village, engagement of villagers
 currently not provided for, measures of user satisfaction, will be used to assess the
 whether the needs identified by the Village Action Plan and consultations are being met,
 both in the short term, medium, and longer term.
 6. Through Action in Rural Sussex, Rural Voices Rural Choices, and our own local Parish
 Council forum, Parishes of the Lower Ouse we will keep abreast of the broader context of
 the wider community.

3.2   Project management
How will you ensure that this project is delivered effectively and is well managed?
 Arrangements will be made for the project to be delivered effectively and well managed
 by establishing a dedicated management trust set up in line with successful good practice
 models and with a comprehensive terms of reference clearly defining objectives.

 A professional project manager or architect with a good track record will be appointed to
 manage the building construction. Contracts will be drawn up following the models used
 by Higher Councils, and awarded in accordance with Local Government procedures.

 The management trust will include representatives from the Kingston Parish Council, the
 Village Action Plan Steering Group and Stakeholder Groups. The Trust will liaise with
 those bodies on a regular basis.

 The Trust will be responsible for sound financial management and required to produce
 audited accounts, monitoring performance, and hold regular meetings with an AGM open
 to the village.

3.3 Project Timetable
Tell us about the timetable for your building project. Tell us the timetable for your building
project including the principal feasibility, design, planning and construction activities and
when you think the project will start and complete. Your project must be able to start within
six months of our offer.
 Project timetable Building project
 April 2007 Preliminary discussions with planning authority confirmed that they will, in principle, support our
 application. Discussions with the Highways Authority confirmed that the will, in principle, support our sustainable
 transport policy, and the installation of cycle racks with no extra parking spaces.
 Preparation for management of building and project
 May 2007 To August 2007
 Seek legal advice from the National Association of Local Councils re formation of Trust and necessary legal
 Consult with other local councils in the area who have recently completed similar projects to ‘find the pitfalls’ and
 identify good practice.
 Identify similar Trusts who successfully manage similar buildings, and consult with them on the model they use.
 Conduct a feasability study and draw up a business plan for the build and for the ongoing management
 This will include costings for the overheads and running costs of the building, and the level of use and rental
 income required to ensure that the building will be self sufficient, so that the building can be operated on a sound
 financial footing from the outset.

 August 2007
 First stage of bid approved and notification of Development Grant approval

 September 2007 : Appoint a safety supervisor to do a pretender plan and liaise with designer, and assess the safety
 of the demolition.
 Tender for an architect/project manager
 October 2007: Appoint Architect/project manager and agree contract in consultation with legal advisors and agree a
 programme, subject to their expert advice, along the following lines:
 November 2007
  Sketch plans drawn up and outline design agreed
 More detailed plans drawn up for consultation with village
 Consultations with village and planning authority
 December 2007 To March 2008
 Amend design if necessary in response to village feedback.
 Appoint Health and Safety coordinator so that safety issues can be dealt with at this time
 Commission detailed plans for planning application
 Project manager produces Gant Chart
 Agree plans and following consultation with planning office, submit application
 Site investigation.
 March 2008
 Prepare building regulations for pre application submission/consultation
 Submit building regulations application.

 Preparation for second stage of bid
 April 2008
 Target date for second stage of bid
 Following succussful bid, Project Manager prepares the tender, and it is advertised. Specification Contract prepared
 using standard form of contract, probably JCT Minor Works Form. Set out in contract the conditions that apply.
 Project manager does Tender Analysis, and recommends best one, based on price, and on the details of the tender
 and knowledge of builder's track record. Builder appointed within one month
 Contract signed with agreed lead time to start date, and finishing dates.
 Appoint Project manager to supervise the building closely, with sitely meetings and monthly financial site meetings
 and issue certificates for work done for payments, and deal with control of omissions, extras and variations.
 Building completed within agreed timescale.

3.4     Equal opportunities
Tell us how the people or organisations that you are targeting will know that the project
exists, will have access to your project and can use the facilities and services provided.

The village and user groups have been involved in the project from the outset. Members
of the community with known disabilities or disabled dependents have been approached
to seek their involvement.

Access to the veranda will be freely available at all times. Access to the lavatories will be
by key, held locally, so these will be opened up when required. Access to the building will
be by a booking system, managed by the Management Trust, who will need to appoint a
booking secretary. Availability, booking secretary contact details, will be publicised via
notice boards, the regular village newsletter, and the Parish Council website and the
Village Website.

Kingston Parish Council has adopted an Equal Opportunities Policy

3.5  Project Budget
Complete the following table to show us how much the project will cost and what you will spend the grant on.
  3.6 Project budget                         Total project costs – include VAT where applicable

                                                                                       VAT recoverable from   Funding from    Grant requested from
                                   Year 1     Year 2                                           total          other sources            BIG
                                                                                                 B                  C                (A-B-C)

  Direct Captial costs
  Construction costs
  Land or building purchase
  Furniture and equipment
  Professional fees
  Non-recoverable VAT

  Total direct capital costs
  Direct revenue costs

  Total direct revenue costs

  Total overheads
  Total project costs

 If you are asking us to fund overheads, what percentage of your
 organisation‟s total overheads does this represent?
Tell us how you have worked out your costs.

3.6        Project funding
If some of the money for your project will come from other sources, tell us where it will
come from. Tell us how much it is and whether you have secured it yet.
                                                                (Tick if applicable)
               Source of funding           Amount                   Yet to be        In kind
                                                                    secured        contribution
 Kingston Parish Council


3.7        Value Added Tax (VAT)
Is your organisation registered for VAT?
Yes              No
 If „Yes‟ please give the VAT number
Have you got in touch with either your local VAT office or a VAT expert to find out how
much VAT you can recover on the cost of your scheme, and do your budget costs reflect
Yes              No
If you have answered „No‟ to the above question, describe below what you have done to
make sure that you will incur no extra costs as the result of irrecoverable VAT. Can you
meet any extra costs that may occur? This is important, as we cannot increase our grant at
a later date.

As a Parish Council we are advised that we are exempt from VAT

We are currently in correspondence with the VAT office regarding recovery of any VAT

3.8 Development grant
If you are invited to submit a stage two application will you want a development grant?

Yes                                                    No

How much development funding would you like from us?

                            Budget heading                         Amount requested
 Architect/Project management fees and expenses

 Safety officer

 Legal & Planning

 Structural engineer

 Site Investigation

 Total development grant request

Tell us how you will use the development grant and explain how you have worked out your

Section 4 – Finishing your application form
What you need to send us
If you would like to send us the application form by email, please send it to

Let us know that you have done this by ticking the relevant box below. In this case, you
must send hard copies of any other documents including all of section four, so that we have
your original signatures. If you would like to send us the application form by email please
send it . Let us know that you have done this by
ticking the relevant box below. If you choose to send us the application form by email, you
must send hard copies of any other documents including all of section 4 as we need to
receive the original signatures.
To be considered for a grant you must send any additional information we have asked for..

This checklist will help you to check that you are sending us a fully completed application.
Please tick the following boxes to confirm that:
 The main contact (signatory one) has signed the declaration on page 17
 The chair, chief executive or person of similar authority (signatory two) in your
 organisation has signed the declaration on page 18.
 If you are a company, either two directors or a director and the company secretary
 have signed the declarations on page 19.
 If you are not a parish council, this form must be signed by an independent referee
 on page 20.
 If you are an unincorporated association and not registered with the Charity
 Commission, you have sent us a signed copy of your governing document (for
 example, constitution, set of rules or trust deed). This must be a hard copy.
 If you are a church-based faith organisation, you have the appropriate consent.
 You have emailed your application form to us.
 You are sending all the documents to us together.
 You have sent us your most recent annual accounts (only if we have asked for
 You have sent us an of your most recent original bank or building society (not a
 photocopy). We will return this to you.
 You have sent us your Surveyor‟s report, if you have one

 You have sent us confirmation of Planning Permission, if you have it.

 You have sent us a copy of the lease, if you have one.
 If your application involves work on Church of England consecrated ground, you
 have sent us confirmation of your faculty permission (if you have it).

Data Protection Act
We will use the information you give us on this application form and supporting documents,
during assessment and the life of any grant we award you, to administer and analyse
grants and for our own research.
We may give copies of this information to individuals and organisations we consult when
assessing applications, when monitoring grants and evaluating the way our funding
programmes work and the effect they have. These organisations may include accountants,
external evaluators and other organisations or groups involved in delivering the project. We
may also share information with other Lottery distributors, government departments,
organisations providing matched funding and other organisations and individuals with a
legitimate interest in Lottery applications and grants, or for the prevention or detection of fraud.
We might use the data you provide for our own research purposes. We recognise the need
to maintain the confidentiality of vulnerable groups and their details will not be made public
in any way, except as required by law.
Freedom of Information Act
The Freedom of Information Act 2000 gives members of the public the right to request any
information that we hold. This includes information received from third parties, such as,
although not limited to, grant applicants, grant holders, contractors and people making a
If information is requested under the Freedom of Information Act we will release it, subject to
exemptions; although we may consult with you first. If you think that information you are
providing may be exempt from release if requested, you should let us know when you apply.
We will take your signatures on this form as confirmation that you understand our
obligations under the Data Protection Act 1998 and the Freedom of Information Act 2000
and that you accept that we will not be liable for any loss or damage to you pursuant to our
fulfilment of our obligations under the relevant law.
We confirm that we are duly authorised to sign this declaration on behalf of the applicant
We certify that the information given in this application is true and confirm that the
enclosures are current, accurate and adopted or approved by our organisation.
We understand that any offer of grant will be subject to terms and conditions and we
confirm that the organisation has the power to accept this grant if the application is
successful and to repay it if the grant conditions are not met.
We understand that, if we make any seriously misleading statements (whether deliberate or
accidental) at any stage during the application process, or if we knowingly withhold any
information, this could make our application invalid and we will be liable to repay any funds.
We understand that the Big Lottery Fund may commission an evaluation of the programme.
We confirm that we will co-operate with any evaluation related activities which are required
of us by the Big Lottery Fund and further confirm that the Big Lottery Fund may use any
part of our application for evaluation or research purposes.
We have not altered or deleted the original wording and structure of this application form as
it was originally provided or added to it in any way.
We understand that you require each signatory to this form to provide their full name, home
address and date of birth for fraud prevention and detection purposes.
We confirm that our organisation has the legal power to set up and deliver the project
described in this application form.
Signatory one
This must be the main contact named in question 1.4.
I understand that you may contact me during assessment and I confirm that I am
authorised by the organisation for this purpose and that you may rely on any further
information supplied to you by me.
                       Forenames Jacqueline
  Title      Cllr                                          Surname Rowland
                         (in full)    Rosemary
                                                           Date of
  Position   Chairman Kingston Parish Council

 Signature                                                   Date

 On behalf of (organisation name)     Kingston Parish Council
 Home address including postcode

If you would like the Big Lottery Fund to send the main contact information about
itself and the other Lottery good causes, please tick this box. If you do not agree to
this, leave the box blank

Signatory two
This should be the chair, chief executive or person of similar authority in your organisation.
If you are a company, two directors or a director and the company secretary must sign this
I confirm that this application and the proposed project within it has been authorised by the
management committee, other governing body or board, or, if a statutory organisation by a
senior member of staff.
  Title         Mr                         David Frederick Surname         Jarman
                               (in full)
                                                             Date of
  Position      Clerk to Kingston Parish Council
  Home address including postcode

 Address for correspondence (if different from above), including postcode

 Phone number one (or textphone)
 Phone number two (or textphone) if applicable
 Email (if applicable)

 Signature                                          Date

 On behalf of (organisation name)      Kingston Parish Council

Signatory three (for companies only)
This should be another director or the company secretary, if not already signatory two.
I confirm that this application and the proposed project within it has been authorised by the
 Title                                                      Surname
                            (in full)
                                                            Date of
 Home address including postcode

 Address for correspondence (if different from above)

 Phone number one (or textphone)
 Phone number two (or textphone) if applicable
 Email (if applicable)

 Signature                                         Date

 On behalf of (organisation name)

Please fill in this section if you are not a statutory body
Signature of independent referee
I can confirm that I have known this organisation and its work for at least one year or from
its start. I have read this application and support this request for funding and am willing to
discuss this application further. I am willing to talk about the project at a later date if the
application is successful and will provide a written report if you need one. I can confirm that
I am not, at present, and have never been a member, beneficiary or trustee of the
organisation or related to a person who is currently a member, trustee or member of staff of
the organisation.
 Title                                                       Surname
                    (in full)
 Date of Birth                         Occupation

 Professional membership

 Professional membership number
 Business address including postcode, for correspondence

 Phone number day (or textphone)
 Phone number evening (or textphone)
 Email (if applicable)

 Signature                                                   Date

If you are applying for stage 1 please send this form to the address below by noon, 30 April

Community Buildings
Big Lottery Fund
Edmund House
8th Floor
12-22 Newhall St
B3 3NL

Section 5 – Beneficiary monitoring
Please note that this information is being gathered for monitoring purposes only and will not
be used to assess your application.

1. Ethnic background of direct beneficiaries
Is your project directed at, or of particular relevance to, groups supporting people from a
specific ethnic background?
If you have answered „No‟ please go to question two. If you have answered „Yes‟, please
indicate the ethnic background of the people who will benefit from your project, ticking up to
three categories.
     Any other White background
     Mixed ethnic background
Asian or Asian British
     Any other Asian background
Black or Black British
     Any other Black background
Other ethnic background
     Any other

2.        Gender
Is your project directed at, or of particular relevance to, people of a specific gender?
     Yes         If „Yes‟, please tick        Male                  Female

3.        Age
Is your project directed at, or of particular relevance to, people of a particular age group?
If „Yes‟, please tick       0-24 years        25-64 years           65+ years
4.        Disability
Is your project directed at disabled people, or of particular relevance to, people with

5.        Faith
Is your project of particular relevance to people of a specific faith?
If „Yes‟, please indicate the faith of the people who will benefit from your project
(you may select more than one box)

6.        Sexual orientation
Is your project directed at, or of particular relevance to, lesbian, gay or bisexual people?

7.        Staff and volunteers
Please tell us how many permanent jobs will be created through the life of your project
Full time posts (35 hours per week, or more)
Part time posts (less than 35 hours per week)                    1
Please tell us how many volunteer posts will be created through the life of your project
Volunteer posts (10 hours per week, or more)
Volunteer posts (less than 10 hours per week)                    3


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