Community Support Grant
HIGH WYCOMBE TOWN COMMITTEE
APPLICATION FORM UNDER £1,500
There are guidance notes next to each question.
Please write clearly or type.
This form is available in large print on request to
[email protected]
Q1
Group Details
Name
Name of your project if this is different
Main contact for this application
This must be someone from your organisation/group who knows about your project and can be
contacted during office hours. This is normally the person completing the form.
Title
First name
Surname
Position held in the group
Contact address, including full postcode
Postcode:
Email address:
Telephone:
If you have any specific communication needs, tell us what they are.
Textphone
Other
1
Sign language
Other language (please specify)
Q2
When was your group established?...................................................
Q3
What is the legal status of your group? i.e. unregistered voluntary or community
sector organisation; registered charity in England or Wales; waiting to be
registered as a Charity? If a registered charity, what is your charity
number?.......................................
Please also provide evidence of Governance e.g. Constitution, Terms of Reference.
Please supply a list of committee members and their positions.
Q4
Briefly describe the aims and objectives of your group, including details of
projects/activities you currently run.
If you are a new
group, describe the
services/activities
you plan to provide.
Q5
Title
Please give the name of one person we can go for a
reference e.g. Local Councillor, Police Officer,
Religious Group Leader or an individual who has no
vested interest in your group.
First name
Surname
Contact address, including full postcode
Postcode:
Q6
Please tick the box if the organisation, or any member thereof, has a direct or
indirect personal interest with a Wycombe District Council elected Member or
Officer
If yes, please provide details (i.e. who, why, in what respect)
Project Details
Q7 Tell us about the project/activities you are planning
What activities are you planning for which the funding is intended?
Where will your activities take place?
2
Try to be specific
about what you will
achieve and how you
will achieve it.
Tell us how you have
identified the need for
the project, either
within your group or
community, and how
you think your project
will meet this need.
Please explain how you know that people in your community want
this project/activity and what difference you hope the grant will
make.
Q8
What is the timescale of your project/activity?
Dates
Please give a
number, do not put
‘everyone in the
area’. An estimate
is fine if you cannot
be exact.
Q9
How many people do you expect to benefit directly from
your project/activity?
Q10
How will the success of the project/activity be measured?
Q11
What are the main risks for the success of the project/activity and how will these
risks be managed e.g. health and safety, financial challenges
Main Criteria
Q12
Wycombe District Council has Key Aims and Objectives which define the areas of
work that are a priority for the Authority. These priorities will positively contribute
to the Council’s Vision for Wycombe District to be economically strong and the
place to live, work and visit.
It is intended that there is a strong synergy between the priorities, and actions in one area may
contribute to the delivery of more than one outcome.
Please indicate below which outcomes your project will help to achieve. No organisation is
expected to meet every objective.
Regeneration and Infrastructure
 Deliver development projects
 Sustainable balance between homes, jobs and infrastructure
Improving the vibrancy of High Wycombe
3

Please indicate
which
outcomes

your project will help
to achieve.
You are not
expected to
contribute to every
objective.
Cohesive Communities
 Engage with younger people to meets needs and aspirations
 Engage with residents to shape their local area
 Encourage safe communities and strong social cohesion
 Ensure targeted and affordable help for those most in need
 Ensure private housing standards are acceptable
 Address affordability gaps

Value for Money
 Provide services in the most efficient and accessible ways
 Generate new revenue streams
 Consider new development opportunities
 Improved benefit to public services

Financial Information
Q1
Tell us how much money you need for your project/activity
Give us a breakdown of what the money is for.
Item or activity
Totals
Q2
A
Amount
Requested from
WDC
£
£
£
£
£
B
Total cost
£
£
£
£
£
Please use general
headings. In Column A
tell us how much
funding you are
requesting. In column
B tell us about the
total cost. (A detailed
breakdown should be
shown on your income
& expenditure and
project budget).
Remember to add
VAT where it applies.
Please describe what contribution you will be making towards the cost of the
project/activity
Q3
4
If your group has received a grant from Wycombe District Council in the last five
years, please give details
Q4
Please provide details of other organisations you are applying to for this
project/activity or have already received grants in support of this
Value for Money
Q5
Value for Money: Please demonstrate how you will deliver your activities
in an efficient and cost-effective way
This information will assist
us in understanding how
you plan to use your
resources and any grant
awarded to you, to gain
maximum benefit for your
service users.
Q6
If your group has financial reserves, for what purpose are they held?
Q7
If your reserves are more than the amount you are requesting, please explain why
you are making this application
5
Further information
F1
Please give us your bank or building society account details.
Please double check that the information you provide is accurate.
Your group’s account name
Bank/Building Society name
Bank/Building Society address
Sort Code
Bank Account number (must be eight
digits)
or Building society roll number
(Use this box only if you have a Building Society roll number)
You can only
apply for a
grant if you
have a
bank/building
society account
in the name of
your group.
We need this
information to
pay your grant
without delay, if
your application
is successful.
List all the people who are authorised to sign cheques or withdrawals on
this account.
Name
Name
Name
Name
Position in
group
Position in
group
Position in
group
Position in
group
How many people have to sign each cheque or withdrawal
from this account?
We will only pay
grants into an
account which
requires at least two
people to sign each
cheque or
withdrawal.
It is recommended
that these people
should not be
related.
Declaration:
I confirm that to the best of my knowledge and belief, all the information in this application form
is true and correct. I understand that you may ask for additional information at any stage of the
application process.
Signature:……………………………………………
Name:……………………………………………......
Position:………………………………………………
Date:……………………………………
Please remember:
Decisions will be notified within 6 weeks
6
If an application
is knowingly
submitted with
false information
it will be
disqualified and
be withdrawn.
Checklist
Important!
We will only process your application if:


You complete all the relevant questions on the form
The proper people sign the form

You enclose all the necessary documents
Document
Enclosed
Previously
Submitted
Constitution or set of rules
List of Committee Members (showing names and positions)
Equal Opportunities Policy (if appropriate)
Child Protection Policy (if appropriate
Vulnerable Adults Policy (if appropriate)
Projected Income & expenditure and overall budget for this
activity/event
Copies of relevant Certificates of Insurance
Confirmation given in question 6 page 2
Yes
□
Checklist (You complete the checklist below)
Tick

We have answered all the questions on the application form.

The main contact named in Question 1 has signed F1 page 6.

We have made a copy of this application to keep for our reference.
Please remember:
If you have not answered all the relevant questions and sent all the information we require, this
will cause a delay.
If you have not answered all the relevant questions and sent all the information we require, this
may cause a delay. Please therefore ensure that there are at least six weeks from receipt of
applications to an award being approved in order for any additional information to be obtained.
It is essential that there is sufficient time for grant assessments to be carried and decisions
made before the start of your event/project/activity.
Please send your application to the Grants Officer, Community Services, Wycombe District
Council, Queen Victoria Road, High Wycombe, Bucks. HP11 1BB
Please apply the correct postage.
May 2016
7