Community Grant Application Form

Welcome to the Wesleyan Foundation Community Grant application form.

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

Wesleyan Foundation Grants administration is supported by Heart of England Community Foundation. You can view our privacy policy here:

Privacy Policy

Essential Information

To complete this application form you will need evidence of:

Your organisation / company has a management committee / board of trustees / board of directors with at least three unrelated people as members, a list of those directors will be required showing who has bank authorisation.
A written constitution / articles / set of rules.
A copy of your most recent annual accounts or financial records showing your organisation’s balance of funds, income, and reserves.
A bank account in the name of the organisation with at least two unrelated signatories.
A bank statement from the last three months.
Copies of your safeguarding policy (if you will be working with children or vulnerable adults).
Equal Opportunities policy.
Quotes for capital items over £300.
Any Annual Reports, Impact Reports or Case Studies which support your application.

Full information on this grant’s eligibility requirements can be found on our Eligibility Grant Factsheet: www.wesleyan.co.uk/foundation/apply-for-a-grant

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.

This application form is designed to be completed alongside our Wesleyan Foundation Grants Fact Sheets which explain the aims and eligibility information of our grants.

If you are unsure about applying or have any other queries then please e-mail us on: foundation@wesleyan.co.uk and we will be happy to help.

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

Contact Details

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

Address line 1

Address line 2

City

Postcode

Email address

Organisation Details

Organisation name

As it appears on any governing documents.

Please briefly describe the aims and purpose of the organisations.

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

Company website

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

Brief description of Organisation

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

YesNo

Organisation Details

Organisation legal status (select all that apply)

Registered charity

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

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

Name of Project

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

Requested funding start date

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.

Project Description (Please detail what the project involves):

What is needed & how was it identified?

What are the projected benefits/outcomes?

Which of our United Nations Sustainable Development Goals does your project contribute to? (Please tick all that apply)

How will your project support the goal(s) ticked above?

Estimated Metrics

The Wesleyan Foundation is collating metrics to demonstrate its impact. Please consider if you can give an estimate on the metrics listed below. (Some of these metrics may not be applicable to the grant you are applying to)

Number of people who would benefit from the grant:

Number of scholarships:

Number of meals provided:

Number of individuals supported into higher education:

Number of individuals supported into education or employment:

Number of qualifications achieved from people in low socio economic areas:

Number of people who reported an increase in their wellbeing (pre/post comparisons):

Number of doctors, dentists or teachers who report an increase in wellbeing:

Number of Trees planted through Wesleyans donation/activities:

Number of individuals educated about Nature/Environment/Climate action:

Project, Activity or Service 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, activity or service?

£

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

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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.

Your organisation / company has a management committee / board of trustees / board of directors with at least three unrelated people as members, a list of those directors will be required showing who has bank authorisation.

A written constitution / articles / set of rules.

A copy of your most recent annual accounts or financial records showing your organisation’s balance of funds, income, and reserves.

A bank account in the name of the organisation with at least two unrelated signatories.

A bank statement from the last three months.

Copies of your safeguarding policy (if you will be working with children or vulnerable adults).

Equal Opportunities policy.

Quotes for capital items over £300.

Any Annual Reports, Impact Reports or Case Studies which support your application.

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 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

Good Health and Wellbeing	Quality Education	Gender Equality
Reducing Inequality	Climate Action