1Step 12Step 23Step 34Step 41/4Step 1Your Name (required) Your Email (required) Your Job title/ Position (required) Full, legal name of your organisation/group (required) Organisation Address & Postcode (required) Telephone Number (required) Website Address (optional) How Did You Hear About Us? (optional) Next Step0%2. Organisation Type SchoolCommunity Group / Voluntary GroupCharity registered with the Charity Commission NIOther (required) 3. In less than 100 words briefly describe your organisation’s main purpose: (required) 4. Provide a short, summary description about what activities your organisation undertakes and the project this grant would support (for use in any publicity/media statements if successful) (required) : 5. Proposed Project Title (required) : 6. In less than 100 words explain specifically what this project will involve? (required) 7. How do you plan to do it? (less than 100 words, required) 8. How many people will benefit & in what way, and from what geographical area will benefit from this grant and in what way? (required) 9. How would the funding be managed by your organisation? (required) 10. Project start date (required) 11. Project end date (required) BackNext33% This section refers to the financial information surrounding the costs that you are applying for, as well as the overall total project cost. The budget should be broken down in as much detail as possible using relevant budget headings and explanation with the total amount requested completed in full. If you have outsourced costs please demonstrate best value has been sought by providing quotations or a rationale as to why one particular company was chosen. 10. Please provide a breakdown of all sources of income plus detailed costs associated with the project: Expense A Expenditure Category E.g. Equipment Description E.g. Laptop Number of items Item cost Total amount requested Expense B Expenditure Category E.g. Equipment Description E.g. Laptop Number of items Item cost Total amount requested Expense C Expenditure Category E.g. Equipment Description E.g. Laptop Number of items Item cost Total amount requested Total Costings Overall total amount requested (required) Financial Breakdown: Most recent statement of financial accounts (optional) Income Breakdown: Details of other grants applied for within the past 3 years (optional) Project Breakdown: Detailed costing breakdown for this project (required) BackNext Step66% The information you provide will NOT be used to assess your group’s eligibility for funding. It is for monitoring purposes only to enable us to improve our service to the wider community. Please tick all relevant boxes that might apply in each grouping. This project will benefit: 22. Persons of different religious belief: (optional) ProtestantCatholicBuddhistHinduIslam/MuslimJewishSikhOtherMixed religious beliefs focus 23. Persons of different political opinion: (optional) UnionistNationalistOther 24. Persons of different racial groups: (optional) Black AfricanBlack CaribbeanMixed Ethnic GroupOther Ethnic GroupChineseWhiteIrish TravellerIndianPakistaniBangladeshiIrish NationalityBritish Nationality 25. Persons of different age: (required) Under 18Between 18 – 25Between 26 – 5960 and over 26. Persons of different marital status: (optional) MarriedUnmarriedDivorced/SeparatedWidowed 27. Persons of different sexual orientation: (optional) GayBisexualLesbianHeterosexual 28. Male or Female: (required) MaleFemaleTransgendered people 29. Persons with a disability or persons without: (optional) Persons with a disabilityPersons without a disability 30. Persons who care for others: (optional) Care of a childCare of a dependent elderly personCare of a person with incapacitating disabilityWithout dependents All contact details submitted to us will be held on a database. We take your privacy very seriously and will only use your personal information to administer the grant application process and to contact you with information relating to matters that may be of interest to you. Once you hit the ’Send’ button you will no longer be able to make any further amendments to your application. We advise that you read over your application thoroughly before sending. Once we receive your completed application form we will let you know and email you a copy of your completed form. Grant decisions are normally made on a monthly basis so we will let you know within 4 weeks, if your application has been successful. Declaration, I hereby confirm that the information provided in this application form is accurate and truthful to the best of my knowledge. I have not knowingly withheld any information that could reasonably be considered relevant to this application. By ticking this box, you confirm that you accept and understand the agreement and consent to our privacy policy in full. (required) Your Name: Back100% Δ