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									 Community Grant
 Application Form
 (One year/one off activity)
 Welcome to Worcestershire County Council
 Community Grant Programme – Mini Round January 2010


 Supporting Community Based Activity for Older People

The Community Grants programm e is intended to help voluntary and community
groups in Worcestershire who help the community to enjoy a better quality of life.
Grants will support one-off or one year activity.

Before completing this application form, please read the guidance notes, as these will
help you fill in the form. If you are filling it in by hand and there is insufficient space in
any of the boxes to answer the question fully, please continue on a separate sheet
marked with your organisation’s nam e and relevant question num ber. You can
expand the boxes if you are filling it in on your computer.


The supporting inform ation for each of the grants available provides the overall
outcomes for that grant as a guideline for your application. Below is a definition for an
outcome. Please consider this when you come to provide evidence in your application
for this grant.

Outcome /s: The changes, benefits, learning or other effects that are experienced by
an individual as a result of taking part in the planned activities.

               Supporting Community Based Activities for Older People

                                 Information for Applicants

   In addition to the general guidance notes, the information below is given to help
   you to apply for grants to support community based activities for older people.

Types of Grants Available

   For this round there is one type of grant available – the 1 year Community Grant.

           A total amount of £30,000 is available
          The maximum grant that will be considered in a single application is
          Only one application will be considered from any single organisation

Objectives of 1 ye ar Community Grants

    Who should the planned activities be targeted at?

   Your activities must provide support to at least one of the following Priority Groups
   of Older People:

              Older People who have dementia
              Older People who have a physical disability
              Older People who are physically frail and/or have sensory impairm ent
              Older People who are dependent on others for care
              Older People who are socially isolated
              Older People who have a functional m ental illness
              Older People from an ethnic minority group

What Outcome s should the project achieve?

Your activities should achieve at least one of the following key outcomes for older

o     Im proved health and well-being
o     Im proved quality of life
o     Making a positive contribution
o     Exercise choice and control
o     Freedom from discrimination and harassment
o     Econom ic well-being
o     Personal dignity and respect

In telling us how you will achieve these outcom es, you may wish to consider the

o   Will your activities provide friendship and social stim ulation?
o   Will your activities reduce social isolation?
o   Will your activities help to m aintain good physical and mental health?
o   Will your activities support older people to engage in meaningful activities?
o   Will your activities meet cultural needs of older people?
o   Will your activities enable older people to participate in aspects of life that are
    valued and m aintain a sense of purpose?
o   Will your activities support older people in preserving links with their local
o   Will your activities enable carers to take a break?
o   Will your activities help to reduce rural isolation?

What will not be considered for grant funding.

o   Groups whose activities do not support our core values
o   Capital costs or capital projects e.g. m ajor building repairs, equipment
o   Deficit funding, for example if an organisation's balances are in deficit and
    they require funding to clear their deficit.
o   Activities that have already taken place (i.e. not retrospective funding)
o   Assistance with fund-raising costs or events.
o   Activities promoting religious beliefs.

                               Assessment Criteria

We will assess your application against the criteria below. We don’t expect you to
meet them all but the more of them you can dem onstrate you support the more
likely you are to be successful.

o Your activities support at least one of the Priority Groups of Older People (a to
  g) set out above
o Your activities clearly dem onstrate how one or more of the key outcomes (1 to
  7) set out above will be achieved
o Your application shows a relevant degree of planning and managem ent
o Your activities give value for m oney
o Your application shows consideration to sustainability beyond the grant period

o Your activities demonstrate that the best use of income is made where
  possible through the use of volunteering
o Your activities are accessible to the wider community? (e.g. is it being clearly
o Your activities are aimed at people who might not otherwise have the
  opportunity to receive support
o Your activities promote service user involvement
o Your activities fill gaps in current provision
o Please bear in m ind that, because the Council has a limited budget, it is
  possible that even if your application meets these criteria, it may still be

                            Monitoring and evaluation
If you are awarded a grant, you will be expected to provide regular monitoring
information throughout the lifetime of the grant to show how you are using the
grant and how it is achieving its purpose. Details will be specified in the Grant

For more information about this grant, ple ase contact Kay Parry on 01905
            822636 or e-mail

Worcestershire County Council Community Grants
Application Form

1. Name of your
group/ organisation

Address and postcode


Email address

Website (if you have

2. Contact name
of person filling in form

Position in

Daytime telephone if
different from above

Email address if
different from above

3. What sort of grant are you applying for? Please tick the relevant box below.
Supporting Community Based Activities
for Older People

4. How much money are you applying for? Note the maximum am ounts differ for each.
Supporting Community Based Activities
for Older People

Maximum £5,000

5. What are the main activities of your group/organisation?

6. What will your group/organisation use the grant for?

When do you hope your project will start and how long will it last?

Start   …………………..                   Finish ……………………….

7. How do your activities match up to the identified outcomes of the category to which
you are applying? (please read the identified outcomes near the beginning of this form
and the additional inform ation for applicants)

8. Who will benefit from these activities and what difference do you hope your project will m ake to
them ?

9. How m any people will be supported with this grant?

   a) Number:
b) Please state the percentage of users in each age range:
0 – 18 …………         19 – 64 …………          65 – 74 …………          75 plus …………

Please state the percentage of users from each ethnic origin:

White British           White and Black Caribbean               Indian

White Irish             White and Black African                 Pakistani

White Other             White and Asian                        Bangladeshi

Chinese                 Mixed Other                             Asian Other

Caribbean              African                                Black Other

Other ethnic group: Please describe…………

10. In which District do your clients live? Please give percentages for each district

Bromsgrove:                            Malvern Hills:                    Redditch:

Worcester City:                        Wychavon:                         Wyre Forest:

11. How does your organisation ensure it gives equal opportunities for all – including service users,
potential users, volunteers and paid staff?

12. Are your staff and volunteers CRB checked? (Criminal Records Bureau).

Yes                        No                 Not applicable

If No or Not Applicable, please explain why not:

If you work with children, young people or vulnerable adults, do you obtain ‘enhanced checks’?
Yes / No / Don’t know what these are.

If you are an organisation that works with children and young people, do you have safeguarding
policy and procedures?


13. Is your group or organisation formally constituted? If yes please provide details of the date it
was form ally ratified?

                                        YES                                               NO

NB - If your organisation is not formally constituted you can get support and information to do this
from the Worcestershire Infrastructure Consortium please ring Cathy Clements 01905 795098. For
further inform ation please see the supporting guidance which explains why your organisation needs
to be form ally constituted.

14. What sort of group or organisation is yours? Please tick the box which best describes your

Registered Charity (please give the reg.               Company limited by guarantee

Community or self-help group                           Other (please explain below)

15. Does your group/organisation have a m anagement committee or board of trustees? If it has,
how m any people are on it, and how often does it meet?

16. To receive a grant from the County Council your organisation m ust have its own bank or
building society account in the name of the organisation as shown in your governing docum ent.
Cheques and other withdrawals must be signed by at least two people who are not related to each

 Please confirm that you comply with this condition or would be able to set up an account should a
grant be rewarded.

17. What was your group's total gross income, as stated in your        £
most recent accounts?

What was its total expenditure in the same year?                       £

What surplus/deficit was there that year?                              £

Which financial year was this? eg 2006-7                               Year:

What are your current reserves + savings?                              £

18. If you have more than 12 months worth of expenditure in reserves or savings, you should use
these to reduce the size of grant requested. If you do not plan to do this, please explain below why
not (eg explain what any reserves are for).

19. Income for the project/activities for which you are seeking a                  2009-10
grant – state source below eg District Council, Lottery, Trusts etc.
                                                                                 (applied for)
Grant requested from the County Council on this form…                £
                                                               TOTAL £

20. Expenditure for the project/activities for which you are seeking               2009-10
a grant. List the m ain items of expenditure and add up the total.
                                                                                  (estim ated)
                                                                 Total £

21. If you hope to continue this project after one year, what are your fundraising plans to support
this project when this grant finishes?

Please ask a senior Trustee or Management Committee mem ber to read the
declaration and sign the form on behalf of your organisation.
In line with County Council practice we will be publishing successful grant
applications on the County Council website.

I confirm that the organisation/group named in this form has authorised me to sign
this application on their behalf, and that the information contained in this application is
correct, to the best of m y knowledge. I confirm that any grant received will be used
solely for the purposes specified in the application


Name of person signing
This m ust be different from the person who
completed the form and should be a senior
trustee eg Chair

Position in Organisation


            Please return this form by 4pm on Friday 12th February 2010
       The form must be returned by registered post or delivered by hand to:
                          Community Grant Application
                                    VCS Unit
                 Planning, Economy & Performance Directorate
                         Worcestershire County Council
                                   County Hall
                                 Spetchle y Road
                               Worcester WR5 2NP

This document can be made available in other languages and alternative formats (including large
print, audio tape, computer disc and Braille) on request from (Stephanie Jones) on telephone
number (01905 766885) or by emailing (sjones12@worc

                                 For office use only

Grant Ref Num ber:              Assessed by:                    Work inspected by/on:

Date received:                  Panel recommendation:           Ledger code:

                                Grant of £

Date ack. sent:                                                 Cheque/BACs raised:


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