Application Form

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Welcome to the Heart of England Community Foundation application form for The Inclusive Communities Fund - Medium Grants.

Before you proceed with your application, please read the following information carefully.

You will process my details in accordance with the following policies and information:

Essential Information For All Applicants

Questions followed by an asterisk are mandatory and must be answered.

You can save your progress at anytime by clicking 'save my progress and resume later'.

Guidance

Please note that we do not score questions individually. Some have a higher word count because we require more information from you. The questions are designed so that we can determine if your project, activity, or service meets the criteria and so that we can ensure we have all the information the panel require to make a decision. If we think there is some information missing a member of the team will contact you.

Impact Section: please ensure the impact measures & categories selected/number of beneficiaries are realistic and achievable and you are collecting this information throughout the life of your project, activity, or service. These will form the basis for your end of grant reporting.

Before completing this application form, please refer to our Fund Fact Sheets for details of the funding programmes available.

If you are unsure about applying or have any other queries then please contact our Grants Team on 02477800520 or e-mail us: commonwealth@heartofenglandcf.co.uk and we will be happy to help.

Good luck and we look forward to receiving your completed application.

Organisation Details

Organisation name

As it appears on any governing documents.

Does your organisation have its own address that is separate to the home address of any individual associated with the organisation?

YesNo

If the organisation doesn't have an independent location we will use the contact details of the primary contact.

Address line 1

Address line 2

City

Postcode

Email address

Telephone number

There must be no spaces between numbers

The telephone number should be one at which the organisation is easily contactatable, especially during office hours.

Staying connected online

We'd like to keep in touch with you during the grant application process and beyond, so please provide your organisation's website and social media details if you have any.

Website

Facebook

LinkedIn

Twitter/X

Instagram

Do you consent to allowing us to use your details for publicity?

YesNo

Contact Details

These are the details that will be used for correspondence purposes.

The contact person should be someone who has a good knowledge of the application as this is the person we will contact if we have any queries.

First name

Last name

Role within organisation/group

Telephone

There must be no spaces between numbers

Address line 1

Address line 2

City

Postcode

Email address

Organisation Details

Organisation legal status (select all that apply)

Registered charity

Charity number

Charitable Incorporated Organisation (CIO)

Charity number

A registered charity is an organisation that is established for charitable purposes and registered with the Charity Commission.

Unincorporated club or organisation

Groups made up of members of the local community, for example Residents Associations.

Company limited by guarantee with charitable aims

An incorporated firm without share capital, in which the liability of its members is limited by the amount each one of them undertakes to contribute at the time the firm is wound up, usually £1.

Company number

Community interest company

Introduced in 2005, CIC’s, are designed for social enterprises that want to use their profits and assets for the public good.

Other

Please specify

You must select at least one status from the list above

Calculations

Calculation

Validation

Month established

Year established

Please give details of all relevant Qualifications, Memberships or Accreditation. See examples.

If your project, activity, or service contains any training, education, counselling etc please list qualifications of those delivering these sessions. Also list any memberships or accreditation's your organisation may have e.g. British Gymnastics, Football Association, English Cricket Board.

Please describe the overall aims and objectives of your organisation and the activities or services your organisation provides.

Please advise what your organisation aims to achieve.

Organisation Details

Are you part of a larger regional or national organisation?

YesNo

What is the name of the national organisation?

Please describe what activities or services you already provide in the project area?

Is your organisation new and has not yet produced a set of annual accounts?

YesNo

What was your organisation's income over the last complete accounting year?

Expenditure over last complete accounting year?

What end date do the accounts relate to?

What were your unrestricted reserves at the end of your last complete accounting year?

Unrestricted Reserves - Money shown in your accounts at the end of the financial year that can be spent on whatever the management committee see fit. The Charity Commission recommends organisations have 3-6 month unrestricted reserves.

Please explain your reserves

Reserves - Money shown in your accounts at the end of the financial year. These are generally categorised as Restricted and Unrestricted Reserves.

Restricted Reserves - Money shown in your accounts that are to be used only for certain things. Such as other grants awarded for specific projects.

For more information visit https://www.gov.uk/government/publications/charities-and-reserves-cc19/charities-and-reserves

Please provide a 12 month income & expenditure forecast

How did you hear about this grant fund?

e.g. Previous applicant, United By 2022 Legacy Charity (please specify workshop, webinar, newsletter, etc)

Did you have any assistance from United By 2022 Legacy Charity to complete this application?

YesNo

How many of each of the following are involved in the organisation?

Full time paid staff / workers

Part time paid staff / workers

Volunteers

Management Committee or Trustees

Bank details

You will need to attach a bank statement from within the last three months at the end of this application so that we can check the account you want this grant to be paid into, if successful.

Bank name

Bank account name

Bank account number

Sort code

Bank address

Address line 1

Address line 2

City

Postcode

Project, Activity or Service Details

Project, Activity or Service name

If you do not have a name for the project, activity or service that is ok.

Requested funding start date

Please note, all grants will have to be fully spent by the end of December 2024

Our average turnaround time for applications is 8-10 weeks. Please allow a minimum of 12 weeks from submission of your application.

Requested funding end date

This could be up to a period of 12 months from your start date, but this can be less depending on how long you wish to deliver your project for.

If your project, activity or service is on-going, you should enter the start and finish dates of the funding period.

Please enter the local authority in which this activity will take place.

BirminghamCannock ChaseCoventryDudleyRedditchSandwellShropshireSolihullTamworthTelford and WrekinWalsallWarwickshireWolverhamptonPlease select more than 1 if relevant

Please describe the Project, Activity or Service you are applying for.

Please tell us about what you need the money for, you may want to consider the following: - If you are planning to commission research into the barriers people face in accessing the arts, tell us who would do the research, and what benefit it will have. i.e. what you will use it for - What do you expect to achieve, with the grant? - Are there any identified risks in delivering of the project?

Which of the core aims does your proposal best align with?

Bringing people togetherImproving health and wellbeingHelping the region to growPutting the region on the map

How does this project meet one or more of the Inclusive Communities Fund four aims?

How has the community been involved in developing this proposal and how will they be engaged with the delivery of this?

Who will be responsible for the delivery of this proposal and what is their background, qualifications and experience?

What positive changes would this grant make to the lives of people who use this project/service?

Please explain what will change and for whom? This is your opportunity to explain your expected outcomes. An outcome describes the benefits or changes that will happen as a result of your work i.e. the impact your work is having on the community.

Which of the 3 themes of the Commonwealth Community Grants fund does your proposal align with?

Physical activity and sportMental health and well-beingArts, culture and creativity

Please explain how you will measure and report on the positive changes made?

Project

Which category best describes the overall impact your project will have?

Your final evaluation report will ask you to report on these outcomes at the end of your grant

Select the primary outcome for your project, activity or service

Select the second outcome for your project, activity or service, if relevant

Select a third outcome for your project, activity or service, if relevant

Project Details

How many people will benefit from this funding?

We realise that you cannot give exact figures but please estimate as accurately as possible. This information is important and will be used to evaluate the project at the end of the grant period.

Which Local Authority area do the people who will benefit from the proposed activity, live in?

BirminghamCannock ChaseCoventryDudleyRedditchSandwellShropshireSolihullTamworthTelford and WrekinWalsallWarwickshireWolverhamptonPlease select the local authority in which this activity will take place.

Please provide the postcodes where most of the people who would benefit from this funding come from?

You can provide up to five postcodes

Project

Please select the primary beneficiary group for this grant

We are interested to know which beneficiary groups will benefit from this grant

Please select up to two other beneficiaries who will benefit from your grant

Black, asian and minority ethnic Carers Children and young people Ex-offenders/offenders/at risk of offending Families/parents/lone parents Homeless people Lesbian, gay, bisexual and transgendered groups Local residents Long-term unemployed Men Neurodivergent peopleNot in education, employment and training (NEET 16-24) Older people People with alcohol/drug addictions People in care or suffering serious illness People with learning difficulties People with low skill levels People with mental health issues People with multiple disabilities People with physical difficulties People living in poverty Refugees/asylum seekers /immigrants Victims of crime/violence/abuse Women

Calculation

Validation

You can select a maximum of two issues from the list above

Project Details

What is the primary issue that will be addressed by this grant?

Please select a maximum of three other issues that will be addressed by this grant.

Arts, culture and heritage Anti-social behaviour Bullying Caring responsibilities Stronger communities/Community support and development Counselling/Advice/Mentoring Crime and safety Disability and access issues Domestic violence Economy Education, learning and training Employment and labour Emergency/Rescue services Environment and improving surroundings Financial exclusion and financial illiteracy Gangs IT / Technology Harmful practice Health, wellbeing and serious illness Homelessness Housing Language, culture and racial integration Mental health Offending/At risk of offending Poverty and disadvantage Refugees/Asylum/Immigration Religion Renewable energies and recycling Rural issues Sexual abuse Social inclusion and fairness Sport and recreation Stigma/Discrimination Substance abuse and addiction Supporting family life Violence and Exploitation

Calculation IssueCount

IssueCount Validation

You can select a maximum of three issues from the list above

Project

Please select the primary age group that will benefit from this grant

We are interested in knowing which age groups would benefit from this grant.

If applicable, please select a maximum of three other applicable age groups for your grant

Early years (0-4) Children (5-12) Young people (13-18) Young adults (19-25) Adults (26-65) Seniors (65+)

Calculation

Validation

You must select a maximum of three ages from the list above

Budget

To help us understand what you're planning to spend the money on, we would like you to provide a breakdown of your costs

Community event

Are you planning a community event as a part of this project. Please could you also tell us if you have any publicity costs for your overall project?

YesNo

Please give details showing how you have calculated the community event costs. Please also include a breakdown of publicity costs for your overall project.

Requested amount

Total cost

Staff Costs

Are there any staff and/or professional fees costs?
costs?

YesNo

Please give details showing how you have calculated staff costs.

E.g. how many hours, how many sessions, cost per hour and duration of delivery, salary per annum.

Requested amount

Total cost

Volunteer Costs

Are there any volunteers costs

YesNo

Number of volunteers and breakdown of 'out-of-pocket' volunteer expenses

E.g. Travel costs

Requested amount

Total cost

Capital Costs

Are there any capital costs?

YesNoE.g. Small items of equipment

Cost per item & how many items

Requested amount

Total cost

Please provide three quotes for each capital item that costs more than £300

Operational Costs

Are there any Operational/Activity costs?

YesNo

Itemise individual cost elements to the delivery of the project, activity or service

Requested amount

Total cost

Office Costs

Are there any Office, Overhead or Premises costs?

YesNo

Costs related to the delivery of this project/activity only - you may wish to highlight this as a percentage or as apportioned costs.

Requested amount

Total cost

Other Costs

Do you have any other costs that you wish to add? Please note this can include evaluation costs.

YesNo

Cost per item

Requested amount

Total cost

Project Costs

How much are you applying for (including VAT)?

These are the amounts you've entered on the previous page

What is the total cost of the project?

These are the amounts you've entered on the previous page

Edit this text

Is there a remaining balance?

YesNo

Please provide details on how the remaining balance will be covered and whether it has already been secured.

e.g. Other funders, covered by own reserves etc. Have you already secured some elements of this?

Consultation

Has any consultation been carried out with the local community, what was the outcome and how has this influenced the design of this project?

If partners are involved, how and when will they be engaged? Please attach written confirmation of their support for the project.

Post Project Evaluation

What top three outcomes now and in the future for your specific community group(s) do you expect your project to achieve.

How will you evaluate that these outcomes have been delivered?

Additional documents

If you are applying to us for the first time using this form, you need to attach all of the following documents. If you have applied to us using this form within the last 12 months, you only need to attach a recent bank statement.

Please attach a detailed project plan and timetable demonstrating clearly that the project can be delivered within the time period identified.

Bank statement from within the last 3 months - We require an official Bank Statement not a transaction list

Copy of Governing Document e.g Constitution, Mem & Arts

Equal Opportunity Policy

Annual accounts

List of committee members

Safeguarding policy

Declaration and Supporting Documents

I confirm that I am attaching the following documents in support of my application:

Evidence from any other funders that any other funding is agreed and in place

Please provide evidence if you are applying for a grant more than £50,000.00

Evidence from other partners of their support for the project

Evidence such as a Memorandum of Understanding (MoU)

Are there any supporting document?

YesNo

Any other supporting documents (please list)

Any other supporting documents (please list)

• I have the relevant authority to submit this application form on behalf of my organisation.

• I am the named contact for all queries relating to this application.

• The information within this application is accurate and factual. If at a later date, any information within this application is considered to be false or untrue, any offer of a grant award will be withdrawn.

• Heart of England Community Foundation has the right to consult with external agencies such as other funders, strategic partners and local authorities about your application.

• I have read and fully understand the criteria and guidance for the The Inclusive Communities Fund - Medium Grants.

• I have read, and I accept to the processing of my personal data in accordance with Heart of England Community Foundation’s Privacy Statement and Data Protection Policy so that they may contact me about this application. Please see more on our website.

Full Name

Position of Authority

Organisation

Date

Heart of England Community Foundation Declaration

By ticking the box below:

You accept that if you leave the organisation or can no longer fulfill your responsibilities, or someone else takes over responsibility for the grant on behalf of the organisation, you must inform us immediately.
You accept the terms and conditions of the grant as they are set out in this application form and the guidance notes.
You certify that the information contained in this application is correct and that you are authorised by the organisation to accept these conditions on their behalf.
You will only spend the grant for the purposes outlined in this application unless you have received written confirmation, from the Foundation, that you can make a variation of spend.
You accept that the Foundation will, under no circumstances, be liable for any damage, injury or loss of any kind whatsoever to any property or persons occurring as a result of activities undertaken with this grant.
You will ensure that all necessary permits and licenses have been obtained for any event or project funded by the grant and that the event or project complies with all relevant regulations.
You acknowledge that you cannot sell or dispose of any equipment or other assets funded or part funded by the Foundation without first receiving written permission.  If any equipment or assets are sold within their working life without such undertaking, the Foundation can ask for a percentage of the original grant to be re-paid.
You confirm that the grant will not be used for the provision of services to asylum seekers when those services are inconsistent with immigration laws or Home Office policy. You understand this includes, but is not limited to: the promotion of work based training to asylum seekers; the provision of employment to asylum seekers unless they are otherwise permitted to take employment; and the provision of services or activities, to asylum seekers, which are intended to assist with the integration of refugees.
You accept that you must keep all financial records and accounts including receipts for items bought with the grant for at least 6 years. These must be made available to the Foundation if requested.
You give permission for the Foundation to record the information in this form electronically and to contact your organisation by phone, mail or email with regards to this application.
You accept that Heart of England Community Foundation may follow up on successful applicants and potentially feature them in publicity activities.
You accept that if your application is successful, that you are willing to take part in, where appropriate, in any publicity activities.
You agree to Heart of England Community Foundation collecting, processing, storing and sharing information provided on this application, as part of the assessment and monitoring process in line with their Privacy Policy. This includes the sharing of information on grant applicants with grant panel members, donors and approved suppliers e.g., marketing agency. We will also publish a full list of all successful grant recipients externally. This includes group/organisation’s name, amounts awarded, location and purpose of grant.

I confirm that I have read and agree with the terms above and confirm I have read and have agreed to the terms and conditions

Yes

We want The Inclusive Communities Fund to benefit people from a wide range of backgrounds, so we need to collect data to help us identify where there are gaps and to guide our grant-making decisions. Therefore, we would like you to complete a Governance Data Form (Link Below) about the make-up of your organisation’s governing body. This information will not be used to assess your application.

Governance Data Form

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