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Sheffield City Council
BME Older People’s Fund
2017-18 Application Form
1. What is your organisation called? Give the group’s name as it appears on the bank account.
2. Name of project or activity for which you are requesting a grant. Please give a short
description of what you are requesting funding for – no more than 15 words.
3. Please give us your contact details (this person will be known as the Grant Contact).
Full Name (including Title)
Job Title/Position in the Organisation
Contact Address (including Postcode)
Phone Number
Email Address
4. Please give us the address where your activities will take place (including Postcode)
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5. Does your organisation have adequate insurance in place for the activities it plans to deliver?
Yes
No
☐
☐
If no, the application will be rejected at this stage
6. Does your organisation have a Safeguarding Policy and procedures for detailing how and
when it is appropriate that Disclosure and Barring Service (DBS) checks are carried out?
Yes
No
☐
☐
If no, the application will be rejected at this stage
7. Which BME group/community will your proposed activities been aimed at?
8. Which PKW Outcomes and Outcomes Indicators will your proposed activities deliver against?
Projects for the BME Older People’s Fund must be able to deliver against one or both of the
identified People Keeping Well (PKW) Outcomes and at least two PKW Outcome Indicators
under the chosen Outcome (including Improved wellbeing – reduction in social
isolation/loneliness). Projects that cannot deliver against the PKW Outcomes and Outcome
Indicators will not be eligible for funding.
See the Application Guidance for further information on the PKW Outcomes and Outcome
Indicators.
Please indicate which Outcome and Outcome Indicators you will deliver against:
Outcomes
☐Local Inform
and Advise
☐Asset Based
Community
Development
Outcome Indicators
☐Improved wellbeing – reduction in social isolation/loneliness
☐Improved health literacy
☐Increased awareness of, and involvement in, community activities
☐Increased awareness of, and involvement in, community activities
☐Reduced inequalities in access to services
☐Improved wellbeing – reduction in social isolation/ loneliness
☐BME older people report feeling engaged and in control of their health and
wellbeing
☐Increased range of activities to improve health and wellbeing are
established and sustained, in partnership with other organisations
☐More BME older people actively engaged in planning and delivery of
activities
☐Increased range and take up of volunteering opportunities by BME older
people
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9. Please describe and explain what evidence you have used to identify how/why your
activities will be successful in meeting the PKW Outcomes. Your response could include:
 Data from an existing successful project that is shown to work
 Data from the Information Pack provided with this application form
 Evidence that an idea has been developed in conjunction with (or using feedback from)
older people and their families
 Other credible research/data (please provide references)
This question is worth 30% of the total marks for this application.
Maximum 600 words
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10. What activities will be delivered if your grant application is successful?
Please complete the table(s) below, detailing what activities you will deliver, against the appropriate Outcomes and Outcome Indicators. You must:
 Describe what the activity is
 Explain how it will meet the Outcomes
 Identify how many people will benefit
Local Inform and Advise (LI&A)
Please leave the field blank if you are not delivering against that Outcome/Outcome Indicator. This question is worth 35% of the total marks for
this application.
How will the activities meet the Outcomes and
PKW
Outcome Indicators
What activities will you deliver?
Outcome
Outcome Indicators?
Improved wellbeing –
reduction in social isolation/
loneliness
MANDATORY if you choose
LI&A
Improved health literacy
Increased awareness of, and
involvement in, community
activities
Reduced inequalities in access
to services
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Asset Based Community Development (ABCD)
PKW
Outcome
Ref:
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Outcome Indicators
What activities will you deliver?
How will the activities meet the Outcomes and
Outcome Indicators?
Improved wellbeing –
reduction in social isolation/
loneliness
MANDATORY if you choose
ABCD
BME older people report
feeling engaged and in control
of their health and wellbeing
Increased range of activities
to improve health and
wellbeing are established and
sustained in partnership with
other organisations
More BME older people
actively engaged in planning
and delivery of activities
Increased range and take up
of volunteering opportunities
by BME older people
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11. Please explain how many people will benefit from your activities and how you will measure success/impact?
Please complete the table(s) below, against the appropriate Outcomes and Outcome Indicators, detailing:
 How many people will benefit from your activities
 How you will measure the success/impact of your activities – please explain what tools/questionnaires/feedback/measurements you will use
Please leave the field blank if you are not delivering against that Outcome/Outcome Indicator. Please Note: Subject to approval, the measures
and tools you describe here will form part of the monitoring process for successful applicants. This question is worth 35% of the total marks for
this application.
Local Inform and Advise (LI&A)
PKW
Outcome
Outcome Indicators
How many people will benefit?
How will you measure success/impact?
Improved wellbeing –
reduction in social isolation/
loneliness
MANDATORY if you choose
LI&A
Improved health literacy
Increased awareness of, and
involvement in, community
activities
Reduced inequalities in access
to services
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Asset Based Community Development (ABCD)
PKW
Outcome
Ref:
Rec’d:
Outcome Indicators
How many people will benefit?
How will you measure success/impact?
Improved wellbeing –
reduction in social isolation/
loneliness
MANDATORY if you choose
ABCD
BME older people report
feeling engaged and in control
of their health and wellbeing
Increased range of activities
to improve health and
wellbeing are established and
sustained in partnership with
other organisations
More BME older people
actively engaged in planning
and delivery of activities
Increased range and take up
of volunteering opportunities
by BME older people
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12. Please give us a breakdown of how the grant will be spent. You may add or delete lines in
the Item/Activity column as necessary.
Item/Activity
i.e. Activities
Publicity/Admin
Staff/Volunteers
Training
Transport/Travel Costs
Year 1
Year 2
Year 3
Total
Total
~~~~End of the Application Form~~~~
What to do when you have completed this form
Please return this completed application form by email to [email protected] by Friday 10th
March at 5pm. Applications received after this deadline will not be considered.
Please note: If your application is successful and your organisation is not already set up as a
registered SCC supplier, we will need you to set up your organisation in our finance system. You
should receive this request in an email format by our Trade Supplier team asking you to follow a
link that will take you to Sheffield City Council’s secure website to enter your details electronically.
Please do not include any bank details for your group in this form.
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