Inclusion Grant Application Form |

I confirm that the applicant organisation is one of the following: *

Registered Charity

Unincorporated Association

Company Limited by Guarantee

Industrial Provident Society

Parochial Church Council

Parish Council

School

Community Amateur Sports Club

Charitable Incorporated Organisation

Local Authority

Place of Worship

Other Exempted/Excepted Organisation (please explain below)

Company/CIC/Mutuals Public Register Registration number: *

Please Explain Type of Organisation (if necessary) *

Other exempted organisations should provide explanation of their structure here

What is your organisation's charitable status? *

We are a registered charity

We have charitable aims but are not registered

We are exempted/excepted from registration

Registered charity number (if applicable): *

Q1. Organisation details

Name of organisation *

Organisation address *

Website address (if applicable)

If you describe yourself as a Community Amateur Sports Clubs (CASC) please provide your CASC number.

Q2. Contact details

Highest ranking person within your organisation (e.g. Chief Executive)

Position *

First name *

Last name *

First contact person for this application

Position *

First name *

Last name *

Telephone *

Email address *

About your organisation

When did your organisation start? *

DD/MM/YYYY

What does your organisation do? *

(maximum 300 words)

Where does your organisation do most of its work? *

How many people directly benefit from, or take part in, your organisation’s activities each year? *

How many people are involved in running your group?

Trustees/Board/Management Committee *

You must have a governing body of at least three unrelated individuals - see eligibility criteria

Full-time staff *

Part-time staff *

Volunteers (not including trustees/directors) *

Are any of these people related to each other? *

Yes

No

Bernicia Foundation requires applicants to have a governing body of at least three unrelated individuals. Where you indicate that people in your organisation are related, we might ask additional questions about steps you have taken to prevent any potential conflicts of interest.

What is your organisation's income?

Financial year *

Income (Maximum £750,000) *

Expenditure *

Unrestricted reserves (not including designated reserves) *

not more than 6 month's running costs - see eligibility criteria

About this application

I am applying for *

Core costs - CICs and other non-charity enterprises should check eligibility rules as the Foundation does not normally support their day to day costs

Project costs

What will a grant for core costs enable your organisation to do in the coming year? *

(maximum 300 words). CICs and other non-charity enterprises should check eligibility rules as the Foundation does not normally support their day to day costs

Project title *

(maximum 10 words - the title should relate to your project. If you are applying for core costs, put 'core costs', if it is for a specific salary, for example a manager, put 'salary costs of the Manager')

Describe the project or activity you want the grant for *

(maximum 300 words)

Why is the project or activity needed and how do you know it will work? Please include details of any consultations you have held with clients or members of the local community *

(maximum 300 words)

How are your beneficiaries involved in the development of your work? *

(maximum 300 words)

How will you know the work has been successful? *

(maximum 300 words)

How does your organisation ensure it meets its Safeguarding obligations? Please also give an example of an instance where you have dealt with a Safeguarding issue. *

(maximum 300 words)

Which of the following statements best describes the aim of your project? *

Reducing isolation and loneliness

Building citizenship

Removing barriers to employment, training and volunteering

Reducing poverty

Promoting independence

Improving financial wellbeing

Which of the following best describes what you hope your project will achieve? *

Provide services or activities

Create a stronger/more inclusive community

Reduction of inequalities

How many people will benefit directly from this project or activity? *

Please specify the area where the majority of people live who will benefit from your project *

Identify 3 SMART objectives that will be met as a result of the grant. These should link to the answers you gave in questions 9 and 10.

Please refer to the guidance on creating SMART objectives at the end of this form.
Each grant objective should be 25 words or less.

Grant objective 1 *

(maximum 25 words)

Grant objective 2 *

(maximum 25 words)

Grant objective 3 *

(maximum 25 words)

How will you track progress and show whether you have succeeded in achieving your objectives? *

(maximum 300 words) Tell us how you will collect evidence that shows the SMART objectives have been met and explain how you will report on them. For example, written reports, case studies, photos.

Money

How much will the project cost in total? *

Where will the money come from? If you are applying for core costs, please give your annual budget. (Indicate funds already secured with an ‘S’)

Where will the money come from? Text1 *

Where will the money come from? Value1 *

Where will the money come from? Text2

Where will the money come from? Value2

Where will the money come from? Text3

Where will the money come from? Value3

Where will the money come from? Text4

Where will the money come from? Value4

What are you asking us to fund with the grant?

Grant Item 1

Grant Item Total Cost 1

Grant Item Requested 1

Grant Item 2

Grant Item Total Cost 2

Grant Item Requested 2

Grant Item 3

Grant Item Total Cost 3

Grant Item Requested 3

Grant Item 4

Grant Item Total Cost 4

Grant Item Requested 4

Grant Item 5

Grant Item Total Cost 5

Grant Item Requested 5

Grant Item 6

Grant Item Total Cost 6

Grant Item Requested 6

Grant Item Total

Grant Item Total Cost Total

Grant Item Requested Total

I give permission for Bernicia Foundation to share the information in this application with Fusion PR Creative and to use it in any publicity relating to the award of a grant or Bernicia Foundation *

Yes

No

We'd like to help your publicise your organisation's activities and work with Fusion PR Creative to manage this.

By clicking submit I agree to the following:

Inclusion Grant Application Form

Q1. Organisation details

Q2. Contact details

Guidance on SMART objectives