Name of Council
Name of Applicant
Contact address
Position held in the council
Contact tel. no. (daytime)
Email
Name of council chairperson/ relevant committee chairperson
Contact tel. no. (daytime)
Email
Please state the minute evidencing approval of this application by full council
ABOUT YOUR ORGANISATION
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If YES, Which Organisation?
Who else is in your project team?
How many organisations does your project involve? Give details of their role and influence in the project. Please upload to this dropbox , the constitution, governing document, terms of reference, or set of rules for them to demonstrate their governance procedures.
Briefly describe the health and wellbeing supporting events, services, projects and activities currently provided by your council and any partners to this proposal.
ABOUT YOUR SERVICE, PROJECT, EVENT, OR ACTIVITY
What is the amount of grant that you are applying for? (Maximum £2500)
Describe your service, project, event, or activity for which you require a grant:
What will you achieve?
How will you achieve it?
Who will benefit from it?
Approximately how many people will benefit?
Please explain how you know that people in the community want this service, project, event, or activity and what difference a grant will make.
What is the evidence for the identified need of your proposal? Have you consulted your community? Please upload any plans or consultations/surveys to the dropbox
When do you intend to start the project? If the proposal is for an event, when is intended to be held?
How will you measure the success of your proposal? For examples see our guidance document
Please include a brief statement in relation to the environmental impact of your proposal.(Somerset’s climate emergency strategy can be found here)
What are the main risks for the success of the service, project, event or activity and how will these risks be managed? i.e., financial challenge, health and safety, weather, etc
If you are arranging an event, please upload a copy of the relevant insurance certificate, or details of the insurance that will be obtained, to this
dropbox
FINANCIAL INFORMATION
Please give a breakdown of all costs and upload your budget/ plans, etc, to this dropbox
Description of project, event or activity and costs
Amount requested from SALC
Total Cost
Description of project, event or activity and costs
Amount requested from SALC
Total Cost
Description of project, event or activity and costs
Amount requested from SALC
Total Cost
Description of project, event or activity and costs
Amount requested from SALC
Total Cost
Are you seeking match funding support from any other organisation? Examples include Somerset Community Foundation, National Lottery, local supermarkets, businesses, and other national and local organisations.
Organisation approached
Purpose
Amount approved
Organisation approached #2
Purpose
Amount approved
Organisation approached #3
Purpose
Amount approved
If you have not made applications to other organisations for funding, please give your reasons.
Please give details of your fundraising efforts and how much has been raised towards the cost of the project, event, or activity:
Type of activity
Amount raised
Amount still to raise
Type of activity
Amount raised
Amount still to raise
Type of activity
Amount raised
Amount still to raise
Type of activity
Amount raised
Amount still to raise
If your council has received a donation or grant from SALC in the last 3 years, please give details:
Dates and purpose
Amount requested
Amount received
Please list any supplementary information you have uploaded to our dropbox in support of your application. This should evidence the need for the activity for which you are seeking funding (can include additional literature, photos, leaflet, or recent consultation, etc.)
The following supplementary information has been uploaded
APPLICATION CHECK LIST
DECLARATION
We declare that:
• We are delegated by the council to act for it in making this application.
• We have read and accepted the guidance notes and conditions of funding and have answered all questions fully and truthfully. We also declare that any grant made will be used solely for the purpose outlined in this application.
We understand that:
• This application form and supporting information will be copied and circulated to members of the SALC advisory group assessing applications (private data and sensitive confidential data will not be disclosed).
Name of person completing the application
Position in the organisation
Date
Name of appropriate chairperson endorsing the information given in this application
Position in the organisation
Date
Submit Grants Application
