Grant Application 2016

Easton-in-Gordano Pill & Ham Green Community Forum

Application Form

EITHER – Cut and paste this form -> Complete it -> Post it to Secretary, Liz Moore, 3 Lodway Gardens, Pill, BS20 0DL  or email: pillites2@talktalk.net

OR Download a .pdf version here -> Complete it -> Post it to Secretary, Liz Moore, 3 Lodway Gardens, Pill, BS20 0DL or email: pillites2@talktalk.net

Contact Name _________________________________________________

Contact Address ______________________________________________________

__________________________________________________________________

Postcode ________________________________

 

Telephone number ________________  Mobile______________________________

Email address _______________________________________________________

Bank details _________________________________________________________

__________________________________________________________________

Cheque payable to ____________________________________________________

 

Please tell us what you need funding for, who will benefit and how they will benefit relating your application to a specific item in the Parish Plan Action Plan

Funding for _________________________________________________________

Who will benefit? _____________________________________________________

Benefit related to Parish Action Plan _______________________________________

_________________________________________________________________

Total cost of the project £__________________

How much required from the Forum£ _______________

Other sources of other funding£ ___________________

 

Declaration

I confirm that, to the best of my knowledge and belief, all the information in this application is true and correct and I agree to conditions noted below.

Your signature    Date:  

 


Conditions

Recipients of grants from the Community Forum agree:

  1. To provide a short written account of the implementation of the project and its impact on completion.
  2. That any funds allocated to this project will only be released on submission of appropriate evidence of expenditure and that any money not spent within 12 months of the date of approval by Forum will be returned to the general fund.
  3. That any funds allocated will only be spent on the purposes outlined in the application submitted. If there is a need to change the purposes, a revised application must be made to the Forum.
  4. If financial support by the Community Forum beyond this deadline of 12 months is hoped for, a further application will need to be made.  Early notification of the need for such continued support is advisable, if it becomes likely.
  5. If it becomes clear significantly before 12 months have elapsed that expenditure on the project has ceased, the treasurer of the Forum should be informed so that funds are available for use in other ways.
  6. That any equipment purchased using a grant from the Community Forum will be made available to other groups within the community that have an appropriate use for it.


Please return your completed application form to:

Secretary: Liz Moore, 3 Lodway Gardens, Pill, BS20 0DL  pillites2@talktalk.net

Note:  electronic versions of the completed form are preferred.  If you are able to insert a scan of your signature at the relevant point, please do so.  However, applications with typed signatures will be accepted, provided they come from the email address of the person signing the application.

Useful Contacts:

Secretary:  Liz Moore   01275 375091  pillites2@talktalk.net

Forum Treasurer   Maddie Bickle, 373357   embee1011@hotmail.com