Health & Wellbeing Small Grants Application Form

Please ensure that you have read and understood the grants advice & guidance document before completing this application form. If you want to share a copy of this application form with council colleagues to gather information prior to completing it online, you can download a Word copy here.

Please use whole numbers throughout (i.e., £1750 – no pence)

ABOUT YOUR ORGANISATION

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ABOUT YOUR SERVICE, PROJECT, EVENT, OR ACTIVITY

Describe your service, project, event, or activity for which you require a grant:
Please explain how you know that people in the community want this service, project, event, or activity and what difference a grant will make.
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
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.
Please give details of your fundraising efforts and how much has been raised towards the cost of the project, event, or activity:
If your council has received a donation or grant from SALC in the last 3 years, please give details:
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.)

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:
• SALC may ask for additional information at any stage in the application process.
• We will be required to submit details showing how the grant was used. SALC reserves the right to reclaim the grant in the event of it not being used for the purpose specified.

• 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).

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