Section 1 – Organisation details
To be completed by applicants (the lead partner if applying in partnership)
1. Name of your organisation
2. Name of the main contact
Title
First name
Family name
3. Position in organisation
4. Contact details for the organisation
Full address of organisation (including postcode)
Daytime telephone number (landline)
Mobile number
Website address (if applicable)
Email address
5. Type of organisation
What type of organisation are you? Please tick any that apply.
Voluntary and community organisation
(For example, are you a group of local residents or neighbours?)
Social enterprise (or Community Interest Company/other business model)
(For example, are you business with social objectives that reinvests its
profits back into the business or community?)
Registered charity
(Are you a charity registered with the Charity Commission?)
Charity Number……………………………
Co-operative or mutual organisation
Company limited by guarantee
Company Number………………………….
Other (Please state)
6. Summary description of your organisation
Please describe your organisation; this should outline who you are, what you do and
who you help.
(150 words max.)
7. Do you have a bank account in the organisation’s name with two
signatories?
Yes
No
If you are successful, and you do not have a bank account, you will need to open one in
your organisation’s name, or nominate an organisation to hold the grant on your behalf.
You will be asked to provide details of the organisation if you are successful.
Section 2 – About the project
Please note, if you are selected for a grant we might use information in your application
for publicity material.
8. Project theme
Please tick the main area your project will focus on (tick one box only).
a) Anti-social behaviour
b) Violence against women and girls
c) Crime in local neighbourhoods
d) Re-offending
e) Youth crime
f) Drug and/or alcohol problems
9. Summary of proposed work
Please tell us the crime or community safety problem in your local community that you
are proposing to work on.
(150 words max.)
What evidence do you have of the problem?
(150 words max.)
Please tell us what solution you have come up with to deal with this problem.
(150 words max.)
10. Where will the project take place?
Please specify the town/nearest location in which your project will take place.
11. Consultation with the community
ow did you work with other people in your local community to identify th crime or safety
problem? For example, did you make contact with members of the community, involve a
wide range of people, and what evidence did you find?
(150 words max.)
12. Community Involvement
Please tell us how local people will be involved in running the project?
(150 words max.)
13. Innovation
Please describe how your approach to tackling the local crime or safety problem in your
area is innovative. For instance, why is this a new approach? How is your project
different to other work which has been done?
(150 words max.)
14. Life after the project
Please tell us how you intend to continue the project once the funding has come to an
end.
(150 words max.)
15. Activities
Please give us an idea of the activities you plan to carry out, when you intend to do
them, how many people will be involved and what you hope to achieve through them.
What activity will you do?
Date(s) of
Activity
No. of
people
What changes will occur as a
result?
16. How will you know that what you are doing is working?
(150 words max.)
18. Partnerships
Will you work with any other organisation(s)?
Yes
No
If yes, please tell us about the organisation(s) and the role they will have in the funded
work. Please add additional boxes if more than one partner organisation is involved in
the work.
Name of partner organisation
Role in the funded work
19. Your summary budget
Please provide below a breakdown of what you will spend the grant money on.. Please
refer to the Guidance Notes for further information on what the money can be
spent on.
Item
Totals
Cost Year 1
(to 31 March
2012)
Cost Year 2
01 April 2012 –
31 March 2013
£
Total cost
20. Additional funding
If the total cost of your work is more than the amount requested as a grant, please
use the table below to explain where the remainder of the money comes from. If
partners are contributing funding please provide these details here.
Source of
funding
Total
amount
applied for
Date
applied for
Contact
details
if CDF
needs to
verify
funding
Secured
or not
21. How much money are you applying for?
You can apply for funding from 31 August 2011 until 31 Mar 2012 and also from 1
April 2012 until 31 March 2013.
31 Aug 2011 – 31 Mar 2012
Min. £1,000 – Max. £15,000
£
1 Apr 2012 – 31 Mar 2013
Min. £1,000 – Max. £15,000
£
Total amount applied for
£
Section 3 – Other Information
Please attach the following, if available:

A letter of support from someone in the local Community Safety Partnership (see
guidance notes)

Do you have a governing document e.g. Constitution, memorandum, articles of
association, rules etc.
( ) YES – If yes please attach ...........................................
( ) NO
We will only consider the information we ask you for. Please do not send us any
additional material such as publications / newspaper clippings, as we will not
consider these or return them to you.