High Peak Borough Council
Hayfield Road
Chapel-en-le-Frith
High Peak
SK23 0QJ

Tel: 0845 129 77 77 or 01298 28400
Monday - Friday, 8am - 8pm
SMS Text: 07800 00 22 62
Minicom: 0845 129 48 76
Fax: 01663 751042

Community Fund 'Small Grants Pot' Application Form

Please make sure you refer to the general criteria notes provided while you are completing this form. Please write clearly in black ink or type.

Tell us about your group

Q1 Contact details

Name of group (as written in your constitution or set of rules):

Name you regularly use, if different from above (or project name, if appropriate):

Name in full, with title, of main contact (for correspondence):
Position held in group:
Address for correspondence, including full postcode:	Enter your address here
Is this the address for your group, your home or other?	Group address, your home or other
Telephone, with full area code:
Mobile phone:
Fax number, with full area code:
Email:
Q2 Are you a branch of a larger organisation or with an umbrella body? Please provide details:
Enter your organisation details here
Q3 Is your organisation a registered charity?	Yes No
If yes, what is the registration number?	State your registration number here
Q4 Is your group fully constituted and non profit making?	Yes No
Q5 When was your group set up?	Please give the month and year
Q6 What are the main activities of your group, or what services do you provide? New groups should tell us about the activities they plan to provide
Tell us your activities here
Q7 How many people are involved in running your group? Put numbers in the boxes:
Committee members:
Full time paid staff:
Part time paid staff:
Volunteers:
Q8 How do people join your group?
How people join your group
Q9 Please give details about your membership Put the number of members in the boxes:
Adult males:
Adult females:
Junior (under 16) male:
Junior (under 16) female:
How many members have a disability?
What is the overall age range?
What are the membership fees?
Any other information	Any other information
Managing your project Q10 How much will the project cost? Please provide a breakdown of the costs of your project, and provide any estimates if obtained. (include VAT where appropriate)
List your items or activities here, with the cost of each, offset by income, such as from ticket sales, and total these up
Q11 Have you applied for any other partnership funding?	Yes No
If yes, please specify details of other sources of finance secured, applied for or considering applying for:`
A. Source/description, approximate value, Secured, applied for, or considering:	Enter details here
B. Source/description, approximate value, Secured, applied for, or considering:	Enter details here
C. Source/description, approximate value, Secured, applied for, or considering:	Enter details here
D. Source/description, approximate value, Secured, applied for, or considering:	Enter details here
E. Source/description, approximate value, Secured, applied for, or considering:	Enter details here
After submitting this application, if you secure other sources of funding, you must inform the Council as soon as possible.
Q12 How much do you seek from the Community Fund?	£
Q13 How will the award be used?
How will you use the award?
Q14 How will your project or organisation contribute to meeting the Council's aims? (See policy and guidance)
Enter details here
Q15 When and where will your event(s), activities or project take place?
C. Date or time period, venue or area:	Enter details here
C. Date or time period, venue or area:	Enter details here
C. Date or time period, venue or area:	Enter details here
C. Date or time period, venue or area:	Enter details here
A large text box has been provided at the end of this form - please continue there if necessary.
Q16 Have we given your group a grant in the past?	Yes No
If yes, please tell us when and what it was for
Enter details here
Q17 Who will benefit from the award? For example, local residents, young people, older people - and how many?
Enter details here
Q18 How will you ensure equality of opportunity in this project?
Enter details here
Q19 Has your proposed activities any other special focus which we should recognise?
Enter details here
Q20 How will you finance your project once you have spent this grant? Please provide your estimates of yearly running costs:
Year 1 Running costs and income:	Enter details here
Year 2 Running costs and income:	Enter details here
Year 3 Running costs and income:	Enter details here
Year 4 Running costs and income:	Enter details here
Q21 Are the following approvals required?
Building regulation	Required Yes No Obtained Yes No
Planning Permission	Required Yes No Obtained Yes No
Q22 Please give details of insurance you either already have, or that you propose to get, in relation to your project.
Enter details here
Q23 Please tell us what impact your project will have on the environment?
Enter details here
Q24 If your organisation or project involves young people under 18 years or vulnerable adults:
1. Do you have a child protection policy?	Yes No
2. Will you be working to implement a child protection policy?	Yes No
If yes, when will this be in place?	Enter details here
Q25 You must include with your application:
a) A copy of your organisation’s audited annual accounts, for the last two financial years
b) A copy of your organisation’s constitution
c) Child Protection policy (if you have one)
Please confirm the details you have included in this form.
Your name in full, with title:
Your position in the group:
Your email address:
Date:
Please type the word: "NOTSPAM"

Community Fund 'Small Grants Pot' Application Form

Tell us about your group

Q1 Contact details

Q2 Are you a branch of a larger organisation or with an umbrella body? Please provide details:

Q3 Is your organisation a registered charity?

Q4 Is your group fully constituted and non profit making?

Q5 When was your group set up?

Q6 What are the main activities of your group, or what services do you provide?

Q7 How many people are involved in running your group? Put numbers in the boxes:

Q8 How do people join your group?

Q9 Please give details about your membership

Managing your project

Q10 How much will the project cost?

Q11 Have you applied for any other partnership funding?

Q12 How much do you seek from the Community Fund?

Q13 How will the award be used?

Q14 How will your project or organisation contribute to meeting the Council's aims?

Q15 When and where will your event(s), activities or project take place?

Q16 Have we given your group a grant in the past?

Q17 Who will benefit from the award?

Q18 How will you ensure equality of opportunity in this project?

Q19 Has your proposed activities any other special focus which we should recognise?

Q20 How will you finance your project once you have spent this grant?

Q21 Are the following approvals required?

Q22 Please give details of insurance you either already have, or that you propose to get, in relation to your project.

Q23 Please tell us what impact your project will have on the environment?

Q24 If your organisation or project involves young people under 18 years or vulnerable adults:

Q25 You must include with your application:

Please confirm the details you have included in this form.