Club Development Grant - 2010 Application Form

							Club Development Grant - 2010                                                                    What project or activities will take place if you receive a grant? (Be specific about what you will
                                                                                                 do and how you will do it, including any event date and time)
Application Form
Please refer to Guidance Notes before completing this form.
Please complete all sections, continuing on a separate sheet where necessary.


Club Name & Address




Your Name                                   Position within club



Your Contact Details (Correspondence Address, Telephone, E-mail)


                                                                                                 Please indicate how you identified the need for the project (what evidence have you
                                                                                                 collected?) and how do you intend to promote the scheme?



Full Name & Address of the National Governing Body (NGB) to which the club is affiliated




Is your NGB fully recognised by Sport England                 [ ] Yes [ ] No
(if no, funding cannot be given to an unrecognised sport)

                                                                                                 How many people do you expect to benefit directly from your project? [        ]
Is your club working towards NGB accreditation (e.g. clubmark, Swim 21)         [ ] Yes [ ] No
                                                                                                 What ages are the people who you hope to benefit through your project? (please provide an
                                                                                                 estimate
Have you contacted your NGB or County Sports Partnership to gain your clubmark resource
pack    [ ] Yes [ ] No                                                                           16-19 [    ]      30-39 [    ]       40-49 [    ]      50-59 [     ]      60+ [    ]
Is your project targeted at any particular group?
                                                                                               Income                                                         £
Women and girls                    [ ]                                                         ..........................................                     ...........
People of minority ethnic origin   [ ]
                                                                                               ..........................................                     ...........
Disability (please circle):        [ ]       Physical   Learning   Visual   Hearing
                                                                                               ..........................................                     ...........
                                                                                               ..........................................                     ...........
Please state why you have chosen this particular project and targeted groups – how will your
project meet our aims?                                                                         ..........................................                     ...........

                                                                                               Grant requested                                                ...........
                                                                                               (expenditure – income)

                                                                                               Please complete this section thoroughly. You can only apply for a grant if you have a bank /
                                                                                               building society account in the name of your group

What three main objectives / targets does your club wish to achieve if successful with the     Account Name                     ..........................................
application                                                                                    Bank name                        ..........................................
                                                                                               Bank address                     ..........................................
                                                                                                                                ..........................................
                                                                                               Account Number                   ..........................................
                                                                                               Sort Code                        ..........................................

How much is your project going to cost and how much are you applying for?
(Please give as much detail as possible. To support your costings please send us the quotes    List two people who are authorised to sign cheques or withdrawals on this account who are
you have based them on. Remember to check our guidelines as to what we will / will not
                                                                                               not related
fund)

Expenditure                                                   £                                Account Name                     ..........................................
..........................................                    ...........                      Account Name                     ..........................................
..........................................                    ...........
..........................................                    ...........
..........................................                    ...........                      Does   your   club   have   an agreed constitution?            [   ]
                                                                                               Does   your   club   have   a child protection policy?         [   ]
..........................................                    ...........                      Does   your   club   have   a health & safety representative   [   ]
..........................................                    ...........                      Does   your   club   have   qualified first aiders             [   ]
Does your club have a current development plan?                                                          [   ]
Does your club have adequate property, personal and public liability insurance                           [   ]
Do your qualified and active sports coaches have their own insurance cover                               [   ]
Does your club have open membership                                                                      [   ]

Please give details of coaches / volunteers involved in delivery of this project

Name              Qualification Held                                                   CRB Expiry Date

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Please read the following terms and conditions before signing and submitting your
application

♦    I understand that the club development grant programme is working to a tight
     timetable. If we have not answered all relevant questions you will not process the
     application

♦    I understand that when you receive a complete application form, a decision will be made
     within 28 working days

♦    I confirm that, to the best of my knowledge, all the information in this application form
     is true and correct

♦    All grant applications are subject to budget availability at the time of submission



Signed
                                                                    Date