Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Shropshire Self-Isolation Support Grant Application Form

How did you hear about this grant?

Please provide more detail

What is the name of your organisation?

Address Of Organisation

Address Line 1

Address Line 2

Address Line 3

Town/City

Postcode

When did your organisation start?

What type of organisation are you?

Please include your Company/Charity Number if applicable

Please describe the main activities of your organisation and who you help

Which area of Shropshire do you work in?

Are you required to undertake Disclosure and Barring Service checks (DBS) for your staff, volunteers and helpers?

Is this funding for a new project or one already established?

Tell us about your project - how will you provide practical help or support to people who are self-isolating (either required to do so or by choice) or who have significantly reduced their social contact due to the Covid-19 pandemic? (max 350 words)

Tell us about your project - how do you provide practical help or support to people who are self-isolating (either required to do so or by choice) or who have significantly reduced their social contact due to the Covid-19 pandemic? (max 350 words)

Please outline your previous experience of delivering a project/service of this type

When will your project start?

When did your project start?

How do you know that there is a need for this project/service?

How did you know that there was a need for this project/service?

Who are your potential beneficiaries? How will you identify them and how will you promote your service to them?

Who are your beneficiaries? How did you identify them and how have you promoted your service to them?

How many people do you estimate will benefit from your project?

How many people do you estimate benefit from your project?

How many volunteers will be needed to support the running of the project?

How many volunteers support the running of the project?

On average, how many hours per week will be provided by volunteers?

On average, how many hours per week are provided by volunteers?

How will you involve the wider community in delivering the project/service? (max 350 words):

How do you involve the wider community in delivering the project/service? (max 350 words):

How much are you requesting? (Please note, applications must be between £500 and £7,000)

Your Project's Budget

Please provide details of costs for your project on a full cost recovery basis. If any of your costs do not fit into these headings please list them in “other costs”. Tell us in the “description of costs” column what each item is and how much it is costing.

	Description of Cost	Total Cost incl. VAT (please don't include '£')
Operational/Activity Costs	e.g. equipment or venue hire
Office, overhead, premises costs	e.g. rent, postage, telephone/fax, heating/lighting/water
Capital costs	e.g. computer equipment, photocopier
Publicity costs	e.g. designing and printing publicity material
Other Costs
Total cost of your Project

If you are not requesting the full cost of the proposed project, where will the balance of funding needed come from?

Payment Information

Account name

Name and address of bank/building society

Sort code

Bank Account Number

Please provide your:

Safeguarding Policy

Please provide supporting documents here:

Please provide your:

Equality and Diversity Policy

Please provide supporting documents here:

Please provide your:

Covid Risk Assessment

Please provide supporting documents here:

Please provide your:

Governing Document

Please provide supporting documents here:

Shropshire Self-Isolation Support Grant Application Form

Contact Information

Main Contact Personal Details

Title

First Name

Last Name

Position

Phone

Other Phone

Email Address

Secondary Contact Personal Details

Title

First Name

Last Name

Position

Phone

Other Phone

Email Address

Shropshire Self-Isolation Support Grant Application Form

Declaration and Agreement

Please ensure that you read the Covid-19 Self-Isolation Grants Scheme 2022 information document as you will be accepting the terms and conditions contained within this document when signing your application form.

Please read this section carefully. We are unable to accept an application if this section has not been completed. It will give details of how we will use the information you have provided in this form, and how we will store it.

By signing you agree that you are making an application for funding and that the information that you have provided is correct to the best of your knowledge.
You accept that if any information changes prior to an award being made you will need to notify Community Resource at the earliest opportunity.
You understand that any grant awarded will only be made payable to the organisation which will benefit from the grant.
You understand that Community Resource will record the information contained on this application form so that we can make an informed decision of whether we can offer you support.
You understand that if you are successful in receiving an award, Community Resource will retain the information on this application form for 7 years. If you are not successful, the information will be retained for 2 years.
You understand that if more information is needed, Community Resource will contact you using the details you provided on the application and you consent to this contact.
You understand to ensure that the grant is used only for the purposes stated in the application and to return any surplus grant funding which is not used for the project applied for.
You understand that Community Resource may use information and images from the application form and follow up impact report for publicity purposes.
You understand that the decision of the grant making panel is final.

Please tick to confirm:

I have completed all questions on the application form as accurately as I can and I understand that unless all relevant information is supplied the grant application may be deferred or rejected.I have read and am able to comply with the terms and conditions of the grant, I understand that any grant offer will be made subject to confirmation confirming that I understand, agree and accept those terms and conditions.

Full Name

Role in organisation

Please upload a written declaration here including Name & Signature

If you are not able to upload a signature or require assistance you can contact enquiries@community-resource.org.uk. You can also submit the form without uploading but we will require you to send us a copy of the relevant signatures before progressing the application.

Keep in touch with us

We would like to contact you from time to time to let you know about our charity projects, fundraising activities and appeals and volunteering opportunities. If you are happy to receive these updates please tick the box below. You can unsubscribe at any point through a link in the footer of the email.

I am happy for you to contact me via email

We may occasionally contact you about our charity work separate to our email updates. Please indicate below that you are happy for us to do so.

I am happy for you to contact me via post

I am happy for you to contact me via phone

You can change your mind at any time by contacting us on 01743 360641 or marketing@community-resource.org.uk

Your details are safe with us. Check out our Privacy Policy for more details.

Please confirm your application is complete and that you have reviewed your answers

I am ready to submit the application

Save my progress and resume later | Resume a previously saved form