Grant Claim Form - Small Grants or Large Grant draw downs

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Small Grant and Large Grant draw down Guidelines for Applicants

Use this form if you wish to if you are applying for a small grant of less than £5,000 from a Designated Fund or drawing down funds from an awarded Large Grant.

Before confirming your submission, please save a copy of your application by selecting the Print option and choosing to save a copy as a PDF.

Draw down funds from an awarded Large Grant

You have been awarded a Large Grant if the charity has issued you with an Grant Letter which includes a reference.

We've streamlined forms so that you no longer have to justify the spend if this claim is going against an awarded Large Grant.

To draw down funds from your Large Grant, please ensure that you have the Grant Reference, Fund Name and Fund Number which can all be found in the Grant Letter.

Select "Spend from a Charity approved Grant" on page 3 of the application form and enter the Designated Fund Name and Number and your Grant Reference where applicable.

Please note, the Lead Grant Holder (who the Large Grant is addressed to on the Grant Letter) will be asked to approve all draw downs against Large Grants.

Help and Support: Please contact grants@supportkings.org.uk with any questions.

Applying for a small grant of less than £5000 from a Designated Fund

Most of our small grants come out of Designated Fund which must be supported and approved by the relevant fund advisor. The list of Designated Funds and Fund advisors can be found here.

Please note the Charity will not pay for any work which is considered to be the core normal function of the NHS.

Procurement of Equipment, goods or services
Please provide supplier quotes and ensure that the supplier is on the Trust Oracle system prior to submitting your application. The Charity will procure off of Oracle at our discretion with Trust approval.

All equipment requests should be approved by the relevant departments (e.g., MEMs) to ensure adherence to the Foundation Trusts procedures and/or to ensure compatibility with existing equipment, on-going maintenance, and adherence to the Trusts standards of care. Please speak to your Service Manager (otherwise General Manager) about getting consent and approval.

We are a small team with limited capacity to process procurement requests. Procurement can take up to one month or longer for large orders. We suggest reimbursement or invoice payment wherever possible.

Reimbursement
The form must be completed by the Trust staff member being reimbursed. Receipts must be provided and can be photographed/ scanned and attached to your application.

Training, education and courses
If you are applying for an external training, education or courses (including King's College London) please get in touch with finance@supportkings.org.uk before submitting an application.

Process for Charity approval
Once the application is approved by the fund advisor, the Charity will review and may come back to you to ask for more clarification on information. We aim to process small grant applications within 10 days.

lf you have any questions, please contact finance@supportkings.org.uk.

All questions with a red Asterisk * are mandatory. If left incomplete you will be prompted at the Review stage to go back and complete.

If you have any questions, please contact grants@supportkings.org.uk

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Please note for reimbursement applications this form must be completed by the Trust staff member being reimbursed.

Applicant Details

Title

First Name

Surname

Job Title

Department, Ward or Area

Care Group

KCH Site where you are primarily based

Please provide the name of the site you are applying from

Organisation

Please provide the name of the organisation you are applying from

Work Phone

Work Email

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Small Grant Details

Type of Grant

Please select if you are applying to; 1. spend from a Charity approved (large) grant (Large grant over 5k with a grant agreement letter and reference only), 2. spend from a designated fund; or 3. to request a grant for Christmas decorations

Please enter details of your designated fund below. If you're not sure of the name or number of your designated fund, please click here to see a full list.

Designated Fund Name

Designated Fund Number. Designated Fund numbers start with 'D' followed by four numbers e.g. D1234

Please enter your grant reference below. This can be found on your grant agreement letter and contains your surname and designated fund number.

Grant Reference

Grant Description

Please select the type of payment request

If the reimbursement request totals £1,000 or more have you received pre-approval from King's College Hospital Charity?

Name of Conference/Training Course

Date of Conference/Training

Has the Training or Education been approved by the Foundation Trust's Education Team?

Are you applying on behalf of other conference/ training attendees?

Page 4 Training, education and courses
If you are applying for an external training, education or courses (including King's College London) please get in touch with finance@supportkings.org.uk before submitting an application.

Attendee Details

Attendee First Name

Attendee Last Name

Attendee Job Title

Attendee Department, Ward or Area

Attendee Work Email

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Procurement requests
All medical items must be available to procure through the Trust's procurement system. Please check in advance of submitting an application and get in touch with the Charity Finance team at finance@supportkings.org.uk if you need to discuss alternative sourcing.

Training, education and courses
If you are applying for an external training, education or courses (including King's College London) please get in touch with finance@supportkings.org.uk before submitting an application.

Please ensure the application amount includes 20% VAT in all instances. This will be included in invoices, however it may not be included in quotes.

Procurement/Raise an Order Only

Item Description

Supplier Name

Quantity

Please ensure the application amount includes 20% VAT in all instances.

Item Amount

£

Total Per Claim

£

Upload Supplier Quote

Does the item require ongoing maintenance/service costs?
If so please provide details of how these ongoing costs will be covered

Total Quantity

Total Amount

£

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Please note that we are a small team with limited capacity to process procurement requests. Procurement can take up to one month or longer for large orders. We suggest reimbursement or invoice payment wherever possible.

Please ensure the contact details are correct. The charity may need to contact you with queries about the order.

Delivery Details

Which KCH site is the order for?

What is the delivery address/es? Note: where there are multiple delivery addresses, please advise below which items are for which address

Name of person receiving the delivery

Contact number for person receiving the delivery

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Bank Details

Please ensure you check the bank details submitted are correct as the Charity is not able to validate them prior to payment. Your bank details will not be shared with anyone other than the Charity Finance team in order to process your claim.

Account Holder's Name

Sort Code

Bank Account Number

Reimbursement and Invoice Payment Only

Item Description

If you are requesting a reimbursement please add the claimant name in the field below. If you are requesting payment of an invoice please enter the supplier name.

Claimant or Supplier Name

Quantity

Item Amount

£

Total Per Claim

£

Does the Supplier Require a PO Number?

Receipt/Invoice Upload

Does your request relate to payment for a patient's family member?

Family Member Details

Make payment to the following recipient (Supplier, Staff Member or Family Member Name )

Family Member First Name
This information will only be used for the purposes of proposing your claim

Family Member Surname
This information will only be used for the purposes of proposing your claim

Family Member Address
This information will only be used for the purposes of proposing your claim

Family Member Email
This information will only be used for the purposes of proposing your claim

Total Quantity

Total Amount

£

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Justification

How will the item(s) be used to benefit patients, families, staff or other service users of King's?

How many patients, families, staff or service users might benefit from this grant each year?
Please provide a figure for each group who might benefit.
For staff Christmas parties please advise how many staff will be attending.

Please explain how this meets the Charity's grant expenditure principles that an item should be over and above what is required for an NHS service

Will your request require Trust approval from the Estates, MEMs, KfM, IT or other teams at the FT? Please speak to your Service Manager (otherwise General Manager) about procurement and getting consent and approval

Which Trust departments have you approached to enquire about any necessary costs or approvals? What Trust approvals are required?

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Small Grants funded out of Designated Funds must be approved by the relevant Fund Advisor. The list of Designated Funds and Fund advisors can be found here.

Large Grant draw downs must be approved by the Lead Grant Holder referenced on the Grant Letter.

If you are the Fund Advisor or Lead Grant Holder, please select 'Yes' below.

Are you the Fund Advisor for the Designated Fund you are applying to or are you the Lead Grant Holder on an awarded Large Grant

Applicant Declaration

I confirm that the expenditure detailed on this form conforms to the Charity’s expenditure principles, is for the purpose detailed in this application and is consistent with the purpose for which the fund was set up.
I have ensured compliance with KCH procurement procedures in terms of procurement waivers and/or obtaining competitive quotes, where applicable.
I have obtained all the required FT approvals and confirm that no other sources of funds are available to fund this expenditure.
I have attached the necessary documentary evidence e.g. approvals, quotations, invoices

I confirm the above statement

I have read and understood the Charity’s Data Privacy Statement regarding the use of the above personal data and confirm I agree to this use of personal data.

I confirm the above statement

Date

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Small Grants funded out of Designated Funds must be approved by the relevant Fund Advisor. The list of Designated Funds and Fund advisors can be found here.

Please ensure you speak to the fund advisor to get support for your application prior to submission. The person named below will be emailed a copy of this form and asked to confirm their authorisation for it through an online process. Please ensure you provide accurate details and you may like to inform them about this process as the Charity will not be able to process your application without these authorisation.

Large Grant draw downs must be approved by the Lead Grant Holder referenced on the Grant Letter. Please enter their details below, they will be emailed a copy of this form and asked to confirm their authorisation for it through an online process.

Christmas Decoration Grants: The fund advisor is Iona Joy, Iona@supportkings.org.uk.

Fund Advisor or Lead Grant Holder Approval

Fund Advisor or Lead Grant Holder Name

Email Work

I confirm that the expenditure detailed on this form conforms to the Charity’s expenditure principles, is for the purpose detailed in this application and is consistent with the purpose for which the fund was set up.
I have ensured compliance with KCH procurement procedures in terms of procurement waivers and/or obtaining competitive quotes, where applicable.
I have obtained all the required FT approvals and confirm that no other sources of funds are available to fund this expenditure.
I have attached the necessary documentary evidence e.g. approvals, quotations, invoices

I confim the above statement

I have read and understood the Charity’s Data Privacy Statement regarding the use of the above personal data and confirm I agree to this use of personal data.

I confirm the above statement

Date

Approval Status

IMPORTANT: In the next screen you will be able to save a PDF copy of your application by clicking Print this page and from the Destination drop down select Save as PDF.