Application Form 2017

Click here to read more about our support fund.

SECTION 1: YOUR ORGANISATION
Name of your organisation:

Address for correspondence:
Contact details:
Your contact must be someone who can talk about the project and funding needs in detail
Position in your organisation:
Address (if different from that above):
Daytime telephone
(please include STD code):
Evening Telephone
(please include STD code):
Email:
Geographic area covered by your organisation:
The project for which you are seeking support must fall within our designated areas – Boynton, Burton Agnes and Rudston
Are you a registered charity?
Yes No 

If yes, include your charity registration number:

You do not need to be a charity to apply but you will need to enclose your constitution or a simple set of signed rules
Is your group part of a larger organisation or is it purely a local concern?
What is the purpose of your organisation and when was it set up?
In this section, you should detail why your group was set up, what the aims and objectives are and who the beneficiaries are for the work you carry out
SECTION 2: YOUR PROJECT
Title of the project for which you are seeking support:
Please describe the project:
Give details of the project and what you want it to achieve
What improvements to the environment do you aim to achieve?
A clear statement of need will assist here
How will you judge the success of the project?
If you have benchmarks/targets please tell us about them. Be realistic as we shall use them in monitoring the project
If your project impacts upon land or buildings that your organisation does not own, who is the landowner and do you have his/her full permission?
Include here details of any leasing arrangement or if you intend to buy property
Who will carry out the work?
Will it involve volunteers or a contractor?
How will the project be managed?
Please state how it will be managed in both the short and long-term
Will it be fully accessible to the public and how many people do you expect to use it in a typical year?
Please give your best estimate of usage
What is the timescale for the project?
When will it start and finish and are there any key landmarks along the way?
Are you working in partnership on this project with any other groups? If so, please list them:
Include the names of any community, voluntary or statutory organisations that you are working with or are supporting you
SECTION 3: FUNDING
What is the total cost of the project including VAT?
Please provide a breakdown of the main cost elements

Item or activity:









Cost - £









Total cost of items above - £

What funding are you seeking from the CSL, Caythorpe Gas Storage Community Fund?
Is your organisation VAT registered?
Yes No 

If it is registered, what is the recovered VAT on the amount you are seeking from the fund?

What other funding exists or is being sought?
Do you already have funds towards the project and are you applying elsewhere?
Will a grant from us assist in triggering match funding from elsewhere?
Match funding is not a condition of a grant from us but it may assist your case
Will there be any longer-term funding requirements for this project in order to sustain it in the future? If so, are they in place?
We need to be sure that you have considered the running costs
Does your organisation have a bank account and how many signatories are required?
Please provide details
If a grant is awarded, to whom should the cheque be made payable to and to what address should it be sent?
This could be your organisation or the contractor. Cheques cannot be made payable to individuals
DECLARATION
We are authorised to submit this application on behalf of the organisation and certify that the information enclosed is correct. By signing this application form, we agree to abide by the terms and conditions included in the grant guidelines and any additional special conditions within the letter of award. We understand that we will be required to monitor expenditure and to provide the administrators of the Caythorpe Gas Storage Community Support Fund with receipts and reports on progress of the project as required. We give permission for the fund to record the information in this form electronically. We also give permission for the fund’s involvement in our project to be publicised.

Signature 1: (please upload)

Full name: Date:

Signature 2: (please upload)

Full name: Date:

On behalf of: (organisation)

INDEPENDENT REFERENCE
Name:

Occupation:

Contact address:

Daytime telephone:

I can confirm that I know the applicant organisation. I have read this application and the request for funding and am happy to be contacted to discuss the project further.

Signature: (please upload)

Full name: Date:

This section should be completed by someone who knows your organisation and can support your application. It cannot be a member of your management committee, a volunteer or user of your group
CHECKLIST
Please ensure that you have included the following information as it applies to your project. Failure to do so may delay or jeopardise your application. Please use the tick boxes were appropriate.

 The completed application form signed by two people Location plan for the project Photographs of the site Detailed plans Sketch of the work proposed Evidence of the land owner’s permission (if appropriate) Evidence that planning permission (if appropriate) has been obtained

Any of the following supporting documentation is to be emailed separately to simon.taylor@mercury-group.co.uk ensuring your full name and project name are part of the subject title.