APPLICATION FORM

Organisation Information and Key Contact Details

Name of organisation
Organisation details:
Address
Email
Telephone Number
Website
Is this organisation a profit making concern?	Yes/No
Registered Charity?Charity Number	Yes / No
Please provide a brief description of your organisation (i.e. what does it do)
Contact person	Enter details of a contact person if we have a question in relation to this grant application
Name
Address
Telephone
Email
Number of members in the Group

Grant Application Particulars

Amount
Purpose for which the grant would be used
Reason for grant application
How will it benefit residents of the parish?
How will the money be spent?
When will the money be spent?

Financial Position

Total spent by the group in the year
Total received by the group in the year
Main income sources – please itemise
Current bank balance (please state date)
Have you applied to any other body for a grant towards the proposed project? If yes, please provide evidence, including the amount.
How else do you raise income?
If this grant application fails, what would happen?

If your application is successful

How do you intend to keep the Parish Council informed about the project?
How will your organisation recognise the grant by the Parish Council?
Who should the cheque be made payable to?

Special Considerations

 Application declaration

I declare that to the best of my knowledge the statement made in this application form, including any accompanying sheets, are true.

Signature………………………………………………………………………………………..

(electronic submissions can use electronic signatures)

Print Name………………………………………………………………………………………

Date………………………………………………………………………………………………

All grant applications must be supported by a financial statement (e.g. statement of accounts, income & expenditure) Any figures should be for the last financial year of the organisation. 

Completed applications must be sent to the Clerk by email: http://www.templecloud.org.uk/council-structure/clerk/

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