Medium Grants Programme(£2,501 - £10,000)
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The Halifax Foundation for Northern Ireland will no longer be accepting applications completed by a professional fundraising consultant
Has this application form been completed by a professional fundraising consultant?
Please select...
Yes
No
You will not be able to submit an application that has been completed by a
professional fundraising
consultant.
Do you have adequate insurance cover to run your charity and this project
?
Please select...
Yes
No
You will not be able to submit an application
if you do not have
adequate insurance cover to
run your charity and this project
.
Organisation
IMPORTANT NOTICE:
Due to the COVID19 crisis, we have broadened our criteria temporarily. We will now consider applications from constituted groups not yet registered as a charity with the Charity Commission or HMRC. Maximum grant award £1,000. If your group falls into this category, please complete the small grant application form.
This application can be saved at any time by ticking the 'Save my progress and resume later' box above and providing your Email address and a Password.
Name of Charity
Date Established
Organisation Details
Address
Town/City
County
Postal Code
Telephone
Please Include Area Code
Email
Website
Correspondence Details (If different from above)
This should be the address you wish all letters to be posted to. Tick here if your correspondence details are different to the above address
Yes
Address
Town/City
County
Postal Code
Email
Main Contact Information
Title
Please select...
Mr.
Ms.
Mrs.
Dr.
Prof.
Miss.
Forename
Surname
Role
Email
Telephone
Mobile
You are currently unsubscribed from our mailing list. If you would like us to contact you in future regarding grant programmes or anything else of interest please
untick
this box.
Opt Out
Finance Contact Information (If different from above)
If your Finance Contact is a different person you can capture that information here by ticking here
Yes
Title
Please select...
Mr.
Ms.
Mrs.
Dr.
Prof.
Miss.
Forename
Surname
Role
Email
Telephone
Mobile
Registered Charity Details
Charity Regulator
Please select...
Charity Commission for Northern Ireland
Charity Commission for England & Wales
Scottish Charity Regulator
Republic of Ireland
Registered Charity Number
Just the Registered Charity "Number" no pre-letters required.
Background To Charity and Present Activities
Please do not provide any personal details (e.g. name) of any individuals in this section
Background to Charity
Please do not leave any of these fields blank. Enter 0 (zero) where applicable
Number of Staff (Full Time)
Number of Committee Members
Number of Staff (Part Time)
Number of Additional Volunteers
Target Area
The Foundation has two main target areas - Education/Training and Social/Community Welfare.
Please pick the theme that best describes the work of your charity.
Please select...
Education/Training
Social/Community Welfare
Target Community
Please pick the type of community that best describes the work of your charity.
Please select...
Serving Mainly Rural Community
Serving Mainly Urban Community
Present Activities
Considering your activities further, please pick one that best
reflects the
work
of your organisation
Please select...
Advice Service
After School Provision
Arts
Disability Support
Domestic Abuse
Early Years
Ethnic Minorities
Health
Illness
LGBTQ+
Mental Health
Older Years Support
Social Enterprise
Sport
Support for Men
Support for Women
Youth Provision
Please outline the present activities of your organisation (in less than 200 words).
Detail of Project
Please do not provide any personal details (e.g. name) of any individuals in this section.
Title of the Project
Project Start Date
Please describe your project including how the NEED was identified.
Description (200 word limit)
The Foundation aims to support those who are disadvantaged and/or with additional needs in the community. How do you feel this project meets this priority? Describe WHO will benefit and HOW they will benefit.
Project Priority (400 word limit)
Objectives
Outline
briefly
up to three objectives for your proposed project and
how
these will be achieved
Objective 1
How will Objective 1 be Achieved
Objective 2
How will Objective 2 be Achieved
Objective 3
How will Objective 3 be Achieved
How many people will benefit from your project?
Direct Beneficiaries
For example, if the same people will benefit each year, only record them once.
How did you calculate these figures?
Indicate the council area in which the project will take place
Please select...
Northern Ireland Wide
Antrim and Newtownabbey Borough Council
Ards and North Down Borough Council
Armagh City
Banbridge and Craigavon Borough Council
Belfast City Council
Causeway Coast and Glens Borough Council
Derry City and Strabane Disctrict Council - Derry Office
Fermanagh and Omagh District Council - Enniskillen Office
Lisburn and Castlereagh City Council
Mid and East Antrim Borough Council
Mid Ulster District Council - Dungannon
Newry
Mourne and Down District Council
How will you measure the success/impact of your project?
(200 word limit)
Please select the categories below which best describes who your grant will support:
Ethnic Minorities
Homeless
Low-Income Background
Men
Offenders/ Ex-Offenders
Older People
People with a Disability
People with an Addiction
People with an Illness
People with Debt Financial Problems
People with Mental Ill Health
Victims
Victims of Domestic Violence
Volunteers
Women
Young People at risk
Those who suffer from Isolation/ Loneliness
Financial Information
In the form below give a detailed breakdown of the costs you require for this project. Please note the amount sought from the Foundation must be between £2,501 - £10,000
Please enter amounts rounded
up
to the nearest pound.
Example;
Item or Activity : Tutor costs (10 weeks x 2 hours x £20 per hour)
Total Cost : £400
Amount being requested £400
Item or Activity
Name/Description
Total Cost: £
Amount being requested: £
Sub Total (Total Cost)
Sub Total (Amount Requested)
Digital Support
We may be in a position to support your charity with a PC, Laptop or Tablet for Administration purposes. This is offered through a partnership with Computer Recyclers UK.
Tick below you wish to be considered for this support. Your Grants Officer will then discuss this with you as part of the assessment process.
Note: By ticking this box, you allow the Foundation to share your details with Computer Recyclers UK for delivery/warranty purposes.
Apply for PC/Laptop/Tablet
Yes
Funds From Other Sources
If you are seeking funds from other sources please provide details below.
Please enter amounts rounded up to the nearest pound
Funding Body/Source
Name
Amount: £
Secured: £
Pending: £
Date of expected decision
Sub Total (Amount) £
Sub Total (Secured) £
Sub Total (Pending) £
Sustainability and Financial History
Details of how the work will continue beyond the grant
Do you intend to continue this work beyond the life of our grant?
Please select...
Yes
No
If yes, how will you sustain this ongoing Project?If no, why is it a time limited project?
100 word limit
Please provide Financial History for the last Two years.
Please start with the most recent year.
Please only type numbers into money boxes marked with a £.
Do not use decimals (round up to the nearest pound) or commas.
For example, £5,000.00 should be entered as 5000, £50.00 should be entered as 50
Negative values should be proceeded by a minus sign, e.g. -2500
Financial History (First Year - Most Recent)
Fiscal Year
Total Income £
Total Expenditure £
Net Assets £
Unrestricted Reserves £
Financial History (Second Year)
Fiscal Year
Total Income £
Total Expenditure £
Net Assets £
Unrestricted Reserves £
Detail any significant changes in your financial position
Applicants must inform us if a Trustee or relative of a Trustee/Staff Member receives any payments from the charity (excluding out of pocket expenses).
Does a Trustee or relative of a Trustee/Staff Member receive remuneration from the charity
Yes
If yes, please provide details,
Max 100 words
Documents
Please upload and attach an electronic copy of the following documents.
Click 'Choose file' then attach.
Governing Document
Adopted constitution/memorandum/articles/Trust deed which have been signed by an office bearer
Bank Statement
Most recent accounts which have been signed by an independent examiner/auditor and an office bearer
Safeguarding Policy
Attach your safeguarding/child protection and/or vulnerable adults policy. Please attach as one document only.
Declarations
Declaration of Chairperson
Please provide contact details for the current Chairperson of your charity. Note: If the Chairperson is listed as the main contact on Page 1, please provide details of another Committee Member/Trustee.
Chairperson/Committee Member Contact Information
Title
Please select...
Mr.
Ms.
Mrs.
Dr.
Prof.
Miss.
Forename
Surname
Role
Address
Town/City
County
Postal Code
Email
Telephone
Include area code
Mobile
By ticking this box I confirm that the above person has read the application form and I as the main contact have confirmed with them that to the best of their knowledge the information on this application form is accurate and the application has the support of the management of the organisation.
Confirm
Submission
PLEASE NOTE: This form must be completed in full and submitted with all the supporting documentation before your application can be considered by the Foundation.
Upon clicking PROCEED TO SIGNATURE you will be taken to a page where you can review the information you are submitting to us, you will also be asked to electronically sign your name either by using your mouse to 'sign' on the line, or by selecting the 'type your name to sign' option box. You must also provide a valid email address (this can be the same as you provided on Page 1 of the Application form). Once you are happy with the information provided and have filled out your ESignature for you can then click the Submit Signed Response button.
Once this is done
y
ou will receive an email with a verification link to confirm your signature
.
Hence the need for a valid email address. This is very important
,
without confirming your signature we may be unable to progress your application.
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