Office Use Only
Community Grants 4 Application Form
Date Received
Grant Ref
Community Grants 3 (v1 Feb14)
Important – PLEASE READ




This form is designed to be completed electronically, all questions must be answered
Once complete, print and sign the form before submitting a hard copy by recorded post, applications cannot be
accepted via email (please supply all the supporting evidence required)
Please refer to the Community Grants Application Information Pack when completing your application
The GREY sections will expand whilst typing
1. Organisation details - Please complete all of your organisation details in the boxes below
Organisation Name
Contact Name
Address
Postcode
Telephone
Mobile Number
E-mail Address
Legal Status of
Organisation
Annual Turnover
£
Date established
(most recent)
Company No. (if applicable)
Charity No. (if applicable)
£
£
(2 years ago)
(3 years ago)
Number of FTE Staff
Please give details of your organisation’s 3 main funders and the approximate annual value (e.g. Lottery, Local
Authority etc)
Name of Funder
Annual Value
2. Bank details
Account Name
Account Number
Sort Code
Bank Name
Bank Address
Name
Name
Name of account
signatories
(2 required)
Position
Position
Please check this box to confirm that you have enclosed a recent bank statement for this account with
your application. The statement must show the account name, sort code and account number
3. Eligibility - Please read the following statements and check the box to confirm your organisation is eligible.
You must be able to check ALL the boxes below to confirm eligibility
3a
The organisation is part of the voluntary and community/not-for-profit sector (this includes charities,
social enterprises, not-for profit companies and community groups)
3b
The organisation has an independent bank account that the grant can be paid into
3c During the last full year of operations, the organisation’s turnover was less than £1,000,000
3d The organisation has fewer than 20 full-time equivalent staff (FTE = 30 hours)
3e
The organisation has not received funding directly from the European Social Fund (ESF), Skills Funding
Agency (SFA), or Department for Work and Pensions (DWP) in the last 12 months
3f
The organisation has not received an ESF Community Grant within the last 12 months OR a new
application does not exceed the £15,000 limit in a 12 month period
3g If successful, this grant will not be used as match funding or to fund activities funded elsewhere
3h
The organisation will ensure that all project beneficiaries are eligible e.g. age 18 or over and not
employed (as per eligibility details in application information pack)
3i
The organisation has a constitution/governing document showing it’s not-for-profit status
3j
The organisation has policies relating to Equality and Diversity, Safeguarding (including The Prevent
Duty) and Health and Safety
3k
The organisation has in place both employers and public liability insurance as legally required OR
enclosed a letter assuring that insurance will be in place by the start of the project
3l
The organisation has audited OR independently examined accounts OR for companies that have been
operating for less than 12 months, can provide an independent financial referee
4. Main activities - Outline the main activities of your organisation and who benefits from them? (max 250
words – question for information only)
5. Track record - Give details of any similar projects you have delivered, including number of beneficiaries,
types of activities and project outcomes. If you have received an ESF Community Grant in previous rounds, you must
include details of this project as part of your answer (max 250 words)
6. Priority groups- You must tick at least one of the target groups for the project. If none of the boxes apply or
you have additional target groups, tick other and give the details.
Lone Parents
People from ethnic minorities
Females
People aged 50 and over
Disadvantaged communities
Other (please state)
Community Grants 4 - Version 1 July 2106
People with health conditions
or disabilities
7. Overcoming barriers - Describe the specific barriers that prevent the individuals in each of the priority
group (s) you have ticked (in question 6) from accessing learning or gaining employment in your area and how your
planned activity will help them overcome these barriers (max 250 words)
8. Evidence of need - How have you identified the need for the learning activity you want to fund?
(max 250 words)
9. Project summary - Please provide a summary of your proposed project, including details of the number of
hours each participant will be learning, the method of delivery and how you will support progression from the
project (max 500 words)
Project End Date
No later than 28 Feb 2018
Project Start Date
10. Beneficiary recruitment and eligibility – how will your programme recruit participants; and how you
will ensure these participants are eligible to benefit from ESF Community Grants (max 250 words)
11. Outcomes for beneficiaries - What are the changes and benefits for the participants? Describe how this
change is linked to your project activities? (250 words)
The difference, change or
benefits to the participants
How your project will bring about this change
12. Quality of provision - How will you ensure the quality of the learning activities delivered as part of this
project? (max 250 words)
13. Value for Money
How much funding are you
applying for?
(Between £5,000 £15,000)
£
How many
beneficiaries
will benefit?
Approximate
number of
contact hours
per beneficiary
14. Detailed budget breakdown Provide an itemised breakdown of your budget, giving as much detail as
possible
Staff budget (e.g. tutor fees, administration, project management)
Item description and breakdown of hours (i.e. per week, month or
session)
Community Grants 4 - Version 1 July 2106
Total Number
of hours
Hourly
Rate
Total Cost
Other costs (e.g. venue hire, accreditation costs, marketing, stationery, volunteers and beneficiary expenses)
Number and
type of unit
Item description and details
Cost per
unit
Total cost
Capital purchases NB: The total amount must not exceed £1,000 and quotes must be provided for capital items
Number and
type of unit
Item description and details
Cost per
unit
Total cost
15. Health and safety - Give details of where the activity will take place, how you will assess the health and
safety risks to participants and what measures you will put in place to minimise the impact of any risks
(max 250 words)
16. Safeguarding - How will you ensure that vulnerable adults are safe from harm and abuse during your
project taking into account the Care Act 2014 and your implementation of The Prevent Duty ? (max 250 words)
17. Equality and diversity - How will you ensure equality and diversity are considered in all aspects of your
project? (max 250 words)
18. Insurances – Tick to confirm that you hold the following insurance and state the value of cover
Employers Liability Insurance
Yes
No
Value of cover £
Public Liability Insurance
Yes
No
Value of cover £
or Enclose a letter assuring that insurance will be in place by the start of the project
19. Declaration – Please read the below declaration and sign your agreement in the space below. The form
must be printed and signed by two people, including someone from your Board/Management Committee
Community Grants 4 - Version 1 July 2106
 We confirm that the information in this form is correct. If a Community Grant is awarded, it will only be used for
the purpose given and according to any conditions specified.
 We agree to provide all additional documentation required.
 We understand that we will be liable to repay any grant monies received if it is found that any information
supplied is incorrect or if any grant monies that may be awarded are not used as indicated in this application.
 We agree to Humber Learning Consortium (HLC)/Your Consortium Ltd (YCL) undertaking a credit check as part of
the application process.
 We understand that if a grant is awarded, the details of that grant may be subject to further contractual
negotiation.
 If successful, we agree to complete a Health and Safety Declaration and Due Diligence declaration as part of the
grant award process and to attend the mandatory Contract Compliance Workshops.
Signature 1
(person submitting the form)
Signature 2
(member of the management committee)
Name
Name
Position
Position
Date
Date
Signature
Signature
20. Checklist
- Your application cannot be considered unless you can confirm the following:
20a Have you completed all the questions?
20b Has the declaration been signed and dated by the person submitting the form and a member
of the management committee?
20c
Have you enclosed a copy of your Health and Safety Policy?
20d Have you enclosed a copy of your Safeguarding Adults Policy including the Prevent Duty?
20e Have you enclosed a copy of your Equality and Diversity Policy?
20f
Have you enclosed a copy of your governing document/constitution?
20g
Have you enclosed copies of both employers and public liability insurances?
20h Have you enclosed a copy of your most recent audited OR independently examined
accounts? OR if you are a new organisation, listed an independent referee? (please enclose
contact details of referee)
20i
Have you enclosed a copy of a recent bank statement that shows the account name, account
number and sort code?
20j
If you have applied for funding to purchase capital equipment, have you attached relevant
quotes for all capital equipment asked for?
Please send your completed application form to:
Community Grants 4 - Version 1 July 2106
Humber and East Riding
Humber Learning Consortium
63-71 Anlaby Road
Hull
HU3 2LL
Community Grants 4 - Version 1 July 2106
York and North Yorkshire
Your Consortium Ltd (YCL)
Chain Lane Community Centre
Chain Lane
Knaresborough
HG5 0AS