FOOD AID SUPPORT GRANT APPLICATION FORM
Please note that we may not be able to process your application if you do not provide all
the requested information.
1. Name of organisation:
2. Working name:
3. Contact name including
title:
(Mr/Ms/Mrs/Miss etc)
4. Position held:
5. Organisation address
Please include full postcode.
Postcode
6. Daytime telephone
number:
Please include the area code
7. Mobile number:
8. Email address:
9. Website address
10. Charity number:
11. In which geographical
area/s do you work?
12. How many paid staff do
you employ?
13. How many volunteers
do you have?
14. How many people has
your foodbank
supported in the last 12
months? Please
provide a quarterly
breakdown if possible
15. Other than assessment
of need, do you operate
any other criteria for the
receipt of food parcels?
Full time
Part time
Please answer the following questions, on no more than two sides of A4:
16. How do you know there is need for your work, what gaps are there in local food
aid provision and who benefits from the work that you do?
17. Please outline your proposals for addressing the gap identified in question 16.
What difference do you want to make and how does your organisation achieve
this?
18. There is a total grant fund of £120,000. The maximum you can apply for is
£15,000. How much grant are you requesting:
19. How would you use this funding?
20. What would happen if your application was only partially successful?
21. How will you measure and report on the impact the grant has made (evaluation)?
22. Please confirm you have the following in place;
A constitution which sets out how the organisation is managed
YES / NO
A management committee which operates in line with your constitution YES / NO
A bank account in the name of the organisation
YES / NO
A treasurer
YES / NO
An equality of opportunity policy / approach.
YES / NO
Declaration
I certify that all the particulars given in the form are correct and that any grant money received
from Derbyshire County Council will be used for purposes stated in this form. The County
Council reserves the right to reclaim any grant not used for the purposes stated on this form.
I understand that the grant applied for is for this year only, with no expectation of funding in
future years.
I agree that should my application be successful I will provide the following;
 a report detailing the outcomes of this bid/project
 quarterly service user statistics (template form attached).
Further, I understand that if the application is successful that you, or someone else also
authorised on behalf of your organisation, will be required to sign a grant agreement which will
set out the full conditions of grant (which will include additional conditions to those set out
above).
Signed ……………………………………………………………………………………….
Name……………………………………………………Position…………………………..
Date…………………………………….
Applications must be received by 12 noon on Friday 14th November 2014
Please return your completed application form, along with your most recent annual accounts,
to [email protected] or post to Sylvia Green RAD, Town Hall, Bank
Road, Matlock DE4 3NN.
Dealing with your Application
Transparency
If your application is successful, details of grants of £500 and over will be published on the
County Council’s website in accordance with government policy. No personal information will be
published
The information you have supplied in this form will be used to process your grant application. In
order to make a decision on your application some of the de-personalised information provided
may go into a public decision report.
In addition we may be required to disclose information outside the County Council to help
prevent fraud, or if required to by law or in respect of any review, complaint or investigation in
respect of EU state aid.
Full grant applications will be retained for a maximum of 6 years (plus current year).
Information will be retained on a database at the County Council for statistical and
monitoring purposes.