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Minibus Application Form - The Lord's Taverners

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Minibus Application Form - The Lord's Taverners Powered By Docstoc
					                    Giving young people, particularly those with special needs, a sporting chance


                                   MINIBUS APPLICATION FORM

           Please return your completed form to: foundation@lordstaverners.org
                                 and send a hard copy to:
    Head of Foundation, The Lord’s Taverners, 10 Buckingham Place, London, SW1E 6HX

Before you complete your application, please consider the following:

   1. The Lord's Taverners minibuses are based on the current Ford Transit model, with a diesel
      engine. The average cost to the charity of an accessible minibus is £44,000. The minibuses
      are painted in The Lord's Taverners Meadow Green and are branded with our livery, which
      must remain on the vehicle at all times.
   2. All applications must be typed or clearly written
   3. Applications will be accepted from schools/ organisations that cater for young people under
      the age of 25 who have a physical/ sensory/ learning disability. We are unable to support
      schools that cater for socially disadvantaged children, or mainstream schools for children with
      behavioural problems. Please refer to the Disability Discrimination Act 2010 if you are unsure
      whether you meet our criteria.
   4. All sections must be completed with as much relevant detail as necessary
   5. Any incomplete application will be automatically rejected
   6. Our vehicles are registered as Disabled Passenger Class and are exempt from VAT and road
      fund licence. When the vehicle is in use there must be a proportion of passengers with a
      disability travelling at all times. If not, then you may be in breach of the legal requirements set
      by DVLA for this type of vehicle. In addition your insurance may be invalidated. Recipients of
      Lord's Taverners minibuses are not permitted to change the vehicle classification (shown on
      the log book) without prior notification and approval from The Lord's Taverners.
   7. We will require all recipients of our minibuses to be involved in a local PR presentation which
      may take place at the location of the minibus or at one of our regional events
   8. All recipients of our minibuses will be asked to complete a short evaluation questionnaire to
      provide us with feedback and to enable us to improve the services we offer
   9. All recipients of our funding will need to provide a copy of their “Children, Young
      People and Vulnerable Adults Protection and Safeguarding Policy”
   10. Please note: If your self-help donation is provided by a third party they do not automatically
      receive the right to have their logo displayed on the vehicle. This is done at the sole
      discretion of The Lord’s Taverners. If we find you have added additional logos after delivery
      of the vehicle you will be asked to remove them.
                          Giving young people, particularly those with special needs, a sporting chance


                                          MINIBUS APPLICATION FORM
             Please return your completed form to: foundation@lordstaverners.org
                                   and send a hard copy to:
      Head of Foundation, The Lord’s Taverners, 10 Buckingham Place, London, SW1E 6HX

The questions in this application form allow us to gather information we need to decide whether to fund your project.

The Lord’s Taverners give minibuses to provide vital mobility for youngsters with special needs and or a disability. Each
minibus is custom designed and costs in the region of £48,000. Strict policy guidelines apply regarding the allocation and
award of a minibus so please read these carefully. Each case is considered individually by The Lord’s Taverners
Foundation Committee who meet quarterly.

Please write clearly in block capitals using black ink or type.

SECTION 1 – Contact details of Organisation who will use the minibus

Name of Organisation who will use the minibus:

Address of Project:                                                Correspondence Address if different:


                            Postcode:                                                          Postcode:

Name of Correspondent:                                             Position:

Telephone Day:                    Direct Line                      Fax:

Mobile:                                                            Email Address:

Website address:                                                   OFSTED link:

Registered Charity                    Yes / No                     Registration Number:

Date established:




SECTION 2 – About the Project who will use the minibus

Please give a brief description of the work carried out by the school / organisation
How many children are in your care?                              How many: Male……….                Female……….

How many are wheelchair users………….                               How many children have a disability?


Please list the types of disabilities:




Age range: 0 – 11 ………..               12 – 18 ……..         18 – 25 ……….               25+ ………….


Will these numbers increase in the next 12 months?               If yes by how many:
Yes / No

What is the average staff/children ratio?                        Is your school a fee paying/privately funded school or a
                                                                 state run provision?


SECTION 3 – Existing Transport

Have you previously owned a Lord’s Taverners minibus?               If Yes – when did you receive it?

Is this application to: please tick                                 Why do you need to change an existing vehicle/increase
                                                                    your fleet?
Replace an existing Lord’s Taverners minibus           (   )
Replace a minibus not supplied by Lord’s Taverners     (   )
Increase your current fleet of minibuses               (   )
You currently do not have a minibus                    (   )
How many minibuses do you operate?


When was the minibus you are seeking to replace registered?

What is the mileage of the minibus you are seeking to replace?                             Miles

What is the make / model of the vehicle you are replacing?

If the children are not resident how do they get to you?




SECTION 4 – Type of Minibus Required
Details of the minibuses offered by The Lord’s Taverners are shown below. The Lord’s Taverners cannot guarantee the
delivery period which is dependent upon the availability of vehicles from our supplier and funds available from the Charity.
Currently our standard waiting list is 18 months long and our Fast Track waiting list is approximately 6 months from the date
the application is approved. Please tick your preferred choice.


Standard minibuses                                                Standard List              Fast Track
Ford Transit                 15 Seater     (   )                  £10,000 (       )          £20,000      (   )
Ford Transit                 17 Seater     (   )

Wheelchair accessible minibuses - provided with semi-             Standard List              Fast Track
automatic under floor tail lift and removable seats
Ford Transit                 13 Seater     (   )
                                                                  £12,500   (     )          £25,000      (   )
Ford Transit                16 Seater      (   )

Do you have your self-help in place? Yes / No                    If no, when would you anticipate this being available?



Please provide details of your fundraising activities:



Have you approached your Local Authority or applied to another source for assistance with a minibus? If yes please give
details, including date of application and outcome:


Please note : In order to drive a 17 seat standard minibus or 16 seat wheelchair accessible minibus drivers must
                                       st
have passed their driving test before 1 January 1997 or be in possession of a PCV licence.
SECTION 5 – Use of Minibus

Please explain why you need a new minibus and how it will be used.




How will a minibus from The Lord’s Taverners make a difference to your pupils/ clients?




Please set out what activities you will be able to do that you are currently unable to do without a Lord’s Taverners minibus?




What will the positive outcomes of a minibus from The Lord’s Taverners be?




How many days per week will the minibus be used?                 What is your estimated annual mileage?

Will any other group use the minibus? Yes / No                   If Yes, who and how often?



Do they pay to use the vehicle?
SECTION 6 – General

Are you able to provide qualified drivers?            Yes / No    Can you keep the vehicle taxed and insured?      Yes / No

Will the vehicle be kept in a secure place?           Yes / No    Do you have funds to service and maintain minibus?
                                                                                                                 Yes / No

Can you ensure the original artwork is not defaced, added to or   Can you ensure that the minibus will principally be used
changed in any way and will be replaced following any             by young people under 25 years with a disability and
bodywork repairs?                                     Yes / No    their carers?                                     Yes / No



How did you hear about The Lord’s Taverners?

Have received support previously………. Website…….. Word of Mouth……..                Event………        Member……...       Another
Organisation………
Have you applied to The Lord’s Taverners before?                  Was your application successful?                 Yes / No
       Yes / No

If Yes, what was the date(s) of your application(s)?              How much did you receive?



For what purpose was the grant(s) awarded?




What have the principal benefits of our previous funding been for your organisation?




Are you aware of other areas that we support:

Play Spaces Scheme Y/N           Table Cricket Competition Y/N     Sports wheelchair scheme Y/N

Youth Cricket funding Y/N

Please note you can apply for funding from more than one area of our giving. Details of our guidelines and
applications can be found within the Charity section of our website www.lordstaverners.org



SECTION 7 –– Please provide the following details from your most recent annual
accounts:
Account year ending : day/month/year

Total (gross) income                                     £

Total Expenditure                                        £

Balance at end of year                                   £

Savings (reserves, cash, investments)                    £

If your savings are more than your annual
expenditure, what are they for?
Please note: If your self-help donation is provided by a third party they do not automatically receive the right to
have their logo displayed on the vehicle. This is done at the sole discretion of The Lord’s Taverners. If we find you
have added additional logos after delivery of the vehicle you will be asked to remove them.


SECTION 8 – Confirmation and Signature

Please supply a set of your latest annual accounts. Please provide any additional information to support your
application on a separate sheet.

We hereby agree that to our knowledge the above information is correct and that we adhere to the guidelines
set out by The Lord’s Taverners.

All vehicles supplied by The Lord’s Taverners are built to manufacturer’s specifications as disabled passenger
carrying vehicles and are registered as such. The minibuses must be used for carrying passengers with
disabilities at all times. Government Transport Regulations prohibit the use of these vehicles for carrying
passengers for hire or reward. If they are deemed to be used in this way you may be liable for prosecution.
You may also be uninsured.

Please make sure that you submit your application both as a hard copy and electronically. Failure to do
both will mean that we are unable to process your application.


Signature                                                        Position Held

Print Name                                                       Date

                                       Charity No: 306054 – Company Number: 582579
                                                   Updated November 2010
                        Giving young people, particularly those with special needs, a sporting chance


                            MINIBUS SPECIFICATIONS AND DIMENSIONS


15 Seat Factory Minibus                                        17 Seat Factory Minibus

Model : Ford Transit 15 seat factory minibus.                  Model : Ford Transit 17 seat factory minibus.

Engine : 2.4/100 ps-turbo diesel                               Engine : 2.4/100 ps-turbo diesel

Colour : Green with Lord’s Taverner Branding                   Colour : Green with Lords Taverner Branding

Modifications to include speed limiter, visibility pack,       Modifications to include speed limiter, visibility pack,
water type saloon heater, rear view lens, manual slide         water type saloon heater, rear view lens, manual slide
out step, reverse alarm, head bump pads at side and            out step, reverse alarm, head bump pads at side and
rear entrances, school signs, side entrance grab               rear entrances, school signs, side entrance grab
handle.                                                        handle.

Dimensions:      External Length : 5680mm                      Dimensions:        External Length : 6403mm
                 Overall Height : 2390mm                                          Overall Height : 2380mm
                 Rear Width : 2374mm                                              Width : 2374mm
                 Gross Vehicle Weight : 3500 kg                                   Weight : 4100 kg

All seats are M2 tested & fitted with lap/diagonal belts.      All seats are M2 tested & fitted with lap/diagonal belts.




13 Seat Wheelchair Accessible                                  16 Seat Wheelchair Accessible

Model : Ford Transit 350 long wheel base high roof.            Model : Ford Transit 460 long wheel base high jumbo
                                                               van at 4.6 tonne.
Engine : 2.4/100 ps-turbo diesel
                                                               Engine : 2.4/115 ps-turbo diesel
Colour : Green with Lord’s Taverner Branding
                                                               Colour : Green with Lord’s Taverner Branding
Conversion to 13 seat accessible minibus (inc driver)
with M2 floor suitable to carry a maximum of four              Conversion to 16 seat accessible minibus (inc driver)
wheelchairs. All seats are M2 tested & fitted with             with M2 floor suitable to carry a maximum of five
lap/diagonal belts.                                            wheelchairs. All seats are M2 tested & fitted with
                                                               lap/diagonal belts.
Vehicle fitted with Ratcliff Palfinger underfloor
automatic hydraulic tail-lift and school signs.                Vehicle fitted with Ratcliff Palfinger underfloor
                                                               automatic hydraulic tail-lift and school signs.
Vehicle is supplied with four sets of straps and four
sets of double reel inertia wheelchair occupant                Vehicle is supplied with five sets of straps and five
harnesses.                                                     sets of double reel inertia wheelchair occupant
                                                               harnesses.
Dimensions:      External Length : 5981mm
                 Overall Height : 2719mm                       Dimensions:        External Length : 6474mm
                 Rear Width : 2374mm                                              Overall Height : 2729mm
                 Weight : 3500kg                                                  Rear Width : 2492mm
                                                                                  Weight : 4250kg

				
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