JF Application Form

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					                          Staffordshire Joint Funded Portfolio Application Form 2010/11

                                                  All information submitted must be typed
                (This form must be completed by the Headteacher and approved by the Governing Body before submission)
School Name                                                                                DCSF
                                                                                         Contact
      Address                                                                             Name
                                                                                       Tel. Number

SECTION 1 - Project Information
        Please do not leave any blank fields. If a question does not apply to your bid please choose box "No" or "Not Applicable"

1.1    The Scope of the Works - In no more than 1200 characters please describe what the actual scope of the works will be ; i.e. refurbishment
       of the boys toilets or extension to provide an additional science lab or re-modelling of reception to provide a secure entrance




1.2    Is your project an acceleration of the Planned Replacement Programme?

       If "Yes" please attach relevant details.

1.3    Is the project in your School Based AMP/Development Plan?
       YES -       If the answer is yes you must attach a copy of the relevant extract
       NO -        If the answer is no then please explain your reason for submission on a separate sheet

1.4    Does the project address one or more of your highest AMP Condition and/or Suitability priorities as identified in
       "Interprise" (the AMP data system) and agreed with your Development Officer?
       YES -       If the answer is yes you must attach a copy of the relevant extract
       NO -        If the answer is no then please explain your reason for submission on a seperate sheet


1.5       How does your project support the Directorate's priorities as defined in the C&LL Thematic Improvement Plan




1.6    Does your project require planning permission?
       NO          go to 1.7
       YES -       Please provide the following information
            -      Have you applied for planning permission?


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                         Staffordshire Joint Funded Portfolio Application Form 2010/11


           -     Have you obtained planning permission?

      Planning Application Ref.


1.7   Management of the Project
      Do you intend to appoint a consultant (architect, surveyor or similar) to manage the design (inc CDM),
      planning application (if applicable), tendering process and supervision of the contractor (s)
      NO        go to 2.1
      YES       Please provide details



SECTION 2 - Project Finance
Please do not leave any blank fields. If a question does not apply to your bid please choose box "No" or "Not Applicable"
2.1   Have written estimates or quotes or tenders been obtained?
      If "Yes" please attach copies and state which contractor you have selected:




Please give details of total costs involved, indicating source of funding                                               Amount
2.2   Project Cost                                                                                                        £
                                                          Works

                                                          Professional Fees (see guidance for fees)
                                                          Statutory fees

                                                          FAE
                                                                                   (max 10% of the project value)
                                                          ICT
                                                          Other (Please state)
                                                          Contingency i.e. an allowance for inflation (max 10%
                                                          of the project)
                                                          TOTAL PROJECT COST                                        £            -
2.3   Please indicate your sources of funding

Devolved Formula Capital
SCC approved loan
other (please state)




                                                                                 Total amount of your funding £                  -


Amount of Joint Funding Requested (total project cost less your sources of funding)                                 £            -

                                                                       TOTAL PROJECT FUNDING                        £            -

SECTION 3 - Project Approvals
3.1   We confirm that the Governing Body approves the application & the School will comply with all of the requirements of the
      Joint Funded Portfolio




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                      Staffordshire Joint Funded Portfolio Application Form 2010/11

Chair of Governors                                                              Headteacher

      Signature                                                    Signature
          Name
   (please print)                                         Name( please print)

           Date                                                         Date

Please return your completed and signed application form no later than 4pm on 23 October 2009, to:
The Joint Funded Portfolio, Children and Lifelong Learning Directorate, Asset Management and Planning, Unit B, Dyson Court,
Gillette Close, Staffordshire Technology Park, Beaconside, Stafford ST18 0LQ




                                                         Page 3 of 4
        Staffordshire Joint Funded Portfolio Application Form 2010/11 - Additional Information

                                           All information submitted must be typed

School Name                                                                        DCSF
                                                                                  Contact
   Address                                                                         Name
                                                                                 Tel. Number

Additional Information




Project Approvals
We confirm that the Governing Body approves the application & the School will comply with all of the requirements of the Joint
Funded Portfolio

Chair of Governors                                                               Headteacher

      Signature                                                      Signature
          Name
   (please print)                                          Name( please print)

           Date                                                          Date



                                                          Page 4 of 4