agenda item 3 rochdale township …democracy.rochdale.gov.uk/documents/s57314/agenda item 3...agenda...

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AGENDA ITEM 3 ROCHDALE TOWNSHIP COMMUNITIES & ENGAGEMENT PRIORITY GROUP MEETING 18 OCTOBER 2017 Ref Name of project Project description Ward Amount required CE/07/17 Multilingual poetry Multicultural Resource Centre propose to organise a multilingual live poetry reading event to engage and celebrate the linguistic and cultural diversity of Rochdale and its communities. Established poets and the local community will perform at the event and all poems will be translated into English and made available on the day to the audience. (Application form providing information about the project and breakdown of proposed expenditure at Appendix A) Milkstone & Deeplish £1,450 CE/08/17 Milkstone & Deeplish Health Initiative Deeplish Community Centre Association propose to organise weekly sessions and an awareness event to improve the health, wellbeing and welfare of the local community with the focus on isolated and disadvantaged elderly people. Activities will include exercise sessions, gardening, mental health and meditation sessions and an open day offering health checks and guidance/information from professionals/agencies about healthy living. (Application form providing information about the project and breakdown of proposed expenditure at Appendix B) Milkstone & Deeplish £1,500 CE/09/17 Deeplish Multi Activity Club Link4Life in partnership with Deeplish Community Centre propose to establish a Deeplish Multi Activity Club offering regular weekly sports, fitness and physical activity sessions to children 8-12 years old for 25 weeks. The sessions will target both boys and girls from the local and surrounding areas of Deeplish who do not traditionally engage in sport and physical activity. Deeplish Multi Activity Club sessions will take place in the evening each week for 1½ hours in term time facilitated by coaching staff from Link4Life’s Casual Community Coaching Team and Deeplish Community Centre volunteers. The project aims to increase the levels of physical activity amongst young people to improve their health and wellbeing. (Application form providing information about the project at Appendix C) Milkstone & Deeplish £1,500

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Page 1: AGENDA ITEM 3 ROCHDALE TOWNSHIP …democracy.rochdale.gov.uk/documents/s57314/Agenda Item 3...AGENDA ITEM 3 ROCHDALE TOWNSHIP COMMUNITIES & ENGAGEMENT PRIORITY GROUP MEETING – 18

AGENDA ITEM 3

ROCHDALE TOWNSHIP COMMUNITIES & ENGAGEMENT PRIORITY GROUP MEETING – 18 OCTOBER 2017

Ref Name of project Project description Ward Amount required

CE/07/17 Multilingual poetry Multicultural Resource Centre propose to organise a multilingual live poetry reading event to engage and celebrate the linguistic and cultural diversity of Rochdale and its communities. Established poets and the local community will perform at the event and all poems will be translated into English and made available on the day to the audience. (Application form providing information about the project and breakdown of proposed expenditure at Appendix A)

Milkstone & Deeplish

£1,450

CE/08/17 Milkstone & Deeplish Health Initiative

Deeplish Community Centre Association propose to organise weekly sessions and an awareness event to improve the health, wellbeing and welfare of the local community with the focus on isolated and disadvantaged elderly people. Activities will include exercise sessions, gardening, mental health and meditation sessions and an open day offering health checks and guidance/information from professionals/agencies about healthy living. (Application form providing information about the project and breakdown of proposed expenditure at Appendix B)

Milkstone & Deeplish

£1,500

CE/09/17 Deeplish Multi Activity Club

Link4Life in partnership with Deeplish Community Centre propose to establish a Deeplish Multi Activity Club offering regular weekly sports, fitness and physical activity sessions to children 8-12 years old for 25 weeks. The sessions will target both boys and girls from the local and surrounding areas of Deeplish who do not traditionally engage in sport and physical activity. Deeplish Multi Activity Club sessions will take place in the evening each week for 1½ hours in term time facilitated by coaching staff from Link4Life’s Casual Community Coaching Team and Deeplish Community Centre volunteers. The project aims to increase the levels of physical activity amongst young people to improve their health and wellbeing. (Application form providing information about the project at Appendix C)

Milkstone & Deeplish

£1,500

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ROCHDALE TOWNSHIP FUNDS 2017/18APPLICATION FORM

ROCH DALEJJ BOROUGH COUNCIL

REF

Please read the Terms & Conditions and Guidance for Applicants. If YOU need advice or support tocomplete your application form, please contact Rochdale Township Office.

SECTION 1 — NAME OF PROJECT

Name of project Multi-lingual poetry

SECTION 2- APPLICANT DETAILS

a) Name of organisation Multicultural Resource Centre

b) Type of organisation

LI LI LIVoluntary! Registered Sports! Limited Private Social Othercommunity charity leisure club company company enterprise typec) Aims and objectives of your organisation and activities or services it provides

Multicultural Resource Centre exists to develop community cohesion and racial harmony. It also works toprovide information, support and resources to BME Communities requiring assistance in a culturallysensitive manner; to develop monitoring mechanism which will assist in identifying the effectiveness of thoseservices. We also deliver projects with issue based activities, mental health, arts and health andchildren/adult abuse. We also provide training and educational opportunities wherever possible. We havemanagement committee and pool of freelance session workers who deliver our projects with the help of paidstaff and volunteers. Activities will enable local people to accept this diversity, to overcome their fear ofdifference and of change. During the sessions session worker will be promoting dialogue and increaseunderstanding between faith communities. The participants will work together and develop somepresentation.

d) Contact name DR ABDUL SHAKOOR

e) Contact telephone

f) Contact address andpostcode

g) Email address

h) Web address

Form RTO2

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CE/07/17
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APPENDIX A
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SECTION 3— ORGANISATION FINANCES

a) Have you applied for or received a Township grant before?

b) If you have answered yes to question a), please give details belowLast year we received funding for project

c) Does more than 50% of your annual base budgetlincome comefrom Rochdale Council? El Yes No

If yes, detail below the amounts received and Council Services providing budgetlincome to yourorganisation (a copy of your application will be forwarded to your relevant Link Officer for their comments)

EYes LINo

SECTION 4— ABOUT THE PROJECT AND JUSTIFICATIONDetails of the proposed project and what benefits will this project bring for participants,organisation, group or wider community?“Our cultural heritage, identity and languages are all important to us and poetry is a great way to expressthese” This Project is a multilingual poetry live reading that will celebrate cultural diversity and the manylanguages spoken in Rochdale.The aim of this project is to engage and celebrate the linguistic and cultural diversity of Rochdale and itscommunities, think positively and creatively about both the languages people speak at home and thelanguages they are learning England. With over 7 languages, English, Bengali, Persian, Afghani, Polish,Urdu, Kashmiri, Punjabi and Gujrati communities will have more understanding about eachother.We have had two consultation meetings with two English poets, two Kashmiri poets and two Persian poetsin Rochdale and they are keen to work with us to develop this project.The event will be held at Sudden Community Centre where all the poets will perform with local communities.All the poems will be translated in English and available on the day of the event to audience.Benefits:It will made communities to realise that they could be creative with language in ways they had not thought ofbefore. It will make them think differently about the languages they speak and their relationship with eachother.

Project start date December 17 Project completionDecember 17

Form RTO2

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M/23/17 MCRC IT Equipment - Awarded £309.98 and M/24/17 Women of Freedom Booklets - Awarded £200 (Year 2017/18) CE/06/17 Women of Freedom - Awarded £650 (Year 2017-18) M/16/16 Independence Day & Poetry Event - Awarded £400 (Year 2016-17) M/21/16 MCRC website - Awarded £175 (Year 2016-17) M/42/16 MCRC laptop - Awarded £399 (Year 2016-17) CE/13/16 Poetry and history of Asian greeting cards link with Christmas cards - Awarded £500 (Year 2016-17) CE/08/15 Poetry for Humanity & Exhibition - Awarded £1,000 (Year 2015-16) M/65/15 Pothohair (Pothwari) Poetry Event - Awarded £1,000 (Year 2015-16)
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and this year
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SECTION 5— PROJECT FINANCES

a) Cost of project £1490

b) Amountofgrantrequired £1450

c) Amount from other sources

d) Details of other funding —

Funder What they may fund Dates of funding decisions

e) Breakdown of proposed expenditure relating to the amount of grant required

(enclose quotations, cost estimates or extracts from catalogues. At least two quotations will berequired for any items to be funded that will cost £1,000 or more to rlemonstrate value for money).

Expenditure item Cost

20 writers fee £25/each 500Venue hire and PA 150

Translation and Printing 300Refreshments 100Admin cost 50Poster and flyer 1002 planning and 1 evaluation meeting 1505 poetry books in different languages 100

TOTAL 1450

Form RTO2

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SECTION 6- SUPPORTING DOCUMENTATION

Please supply the following documents when you submit your application. IF YOU DO NOT SUPPLYTHESE DOCUMENTS, WE WILL NOT BE ABLE TO PROCESS YOUR APPLICATION. Please tick theboxes to confirm which documents you have attached to this application.a) Annual accounts and bank statement(s)b) Constitution/governing documentc) If your project works with children and young people under 18 years old or vulnerable adults, pleaseconfirm your organisation has the following in place:

Child protection policies and procedures Yes LI N/ADisclosure and Barring Service (DBS) checked staff andYes LI N/Avolunteers

d) Quotes/estimates/extracts from catalogues for proposedexpenditure

SECTION 7 - DECLARATION

We, the undersigned agree to:

. Abide by Rochdale Township Fund’s Terms and Conditions.

. No expenditure being incurred on this project prior to the grant decision being given.

. Certify that the information contained in this application is correct and that we are authorisedby the organisation to accept these conditions on their behalf.

. Use funds, if granted, only as specified in this application, unless receiving authorisation fromRochdale Township Office to make changes.

. Send the invoiceslreceipts for all payments made with this grant along with the completedProject Evaluation Form to the Rochdale Township Office.

. Agree to participate in monitoring, auditing and evaluation related to this fund.

. Highlight the support of Rochdale Township in all publicity material and agree to RochdaleCouncil’s use of the organisation’s name and photographs for promotional purposes.

. Inform Rochdale Township Office immediately if either signatory leaves the organisation orcan no longer fulfil their responsibilities, or someone else takes over responsibility for thegrant_on_behalf of the_organisation.

Contact Person Organisation Chair or Treasurer(Different from Contact Person)

Signature Signature bFull name DrAbdul Shakoor Full name Abid Bukhari

Position Manager Position Chair

Date 21/09/17 Date 21/09/17

Before you send your application to us, please check that you have:• answered all the relevant questions and• enclosed all the information requested:

- Annual accounts - Constitution/governing document- Bank statement(s) - Quotations/cost estimates/extracts from catalogues- BACS form

We will return incomplete application forms.

Please send your completed application form to:Rochdale Township Office, Number One Riverside, Smith Street, Rochdale 0L16 1XUTel: 01706 924802Email: [email protected]

Form RTO2

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10 Milkstone PlaceRochdale

OL1I 3TATel: 01706 346126

Email: [email protected] Registration: 1127743

9

V%J

PcviA It,1t{_lvt

/ S 0

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Co-operative Catering Services

Invoice

Date: 20/09/20 17

To

______Multicultural

Resource Centre________________________________

Rochdale______________________

Description Amount

Refreshments 100.00

Total Due £100.00

Please make your cheque payable to

Thank you

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ZAHID ZAFAR[WRITER AND PRESENTER]

CrumpsallManchester

20/07/ 2017

Multicultural Resource Centre10 Milkstone PlaceRochdale01.11 3TA

Further to our meeting please see the expenses details for the project.I will be working with local writers of Rochdale

20 writers fee £25/each 500

Translation and Printing 300

5 poetry books in different languages 100

Total £900

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From: Sudden Community CentreRochdale

Address:

To: Multicultural Resource Centre10 Miikstone PlaceRochdaleOL11 3TA

Date: 01/10/20 17

INVOICE!QUOTE

Project Name:

Dates of Workshops/events: TBC

No. of workshops:

Charge £150

SUBTOTAL: £150

Materials/expenses:

TOTAL: £150

Please make cheque payable to

and send to if different from above.

Signed

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Form RT02

RROOCCHHDDAALLEE TTOOWWNNSSHHIIPP FFUUNNDDSS 22001177//1188

AAPPPPLLIICCAATTIIOONN FFOORRMM

REF CE/08/17 & W/10/17

Please read the Terms & Conditions and Guidance for Applicants. If you need advice or support to complete your application form, please contact Rochdale Township Office.

SECTION 1 – NAME OF PROJECT

Name of project Milkstone / Deeplish Health Initiative

SECTION 2 - APPLICANT DETAILS

a) Name of organisation Deeplish Community Centre Association

b) Type of organisation

Voluntary/ community

Registered

charity

Sports/

leisure club

Limited

company

Private

company

Social

enterprise

Other type

c) Aims and objectives of your organisation and activities or services it provides

Our Vision

Milkstone – Deeplish is an exciting area of Rochdale which has always embraced and celebrated diversity, and promoted development. It is an area in which residents live and work, but also attracts many visitors due to the thriving small businesses and convenience of other key community assets. Our vision is to be an integral asset to the community and provide a wide range of services which will contribute to the growth and regeneration of the community.

Our Mission - “To serve our community and improve the quality of life of our residents.”

Participation and Quality provision

Deeplish Community Centre provides a friendly, safe and welcoming environment for the local community and user groups, enabling them to participate in educational, social and learning activities. To promote cohesion, empowerment, and integration and employment opportunities for the local communities.

Health and well-being

Our aim is to promote Health and well-being and improve local people’s participation in well-being activities through informal education and support.

We promote social inclusion and community cohesion and support elderly and vulnerable people facing barriers due to age, health, language, disability etc.

Education, Training and Employability

We develop and enhance the skills of local communities through lifelong learning, education and training provisions for everyone - promoting confidence in learning new skills. To support the improvement of

Worrall Sharron
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APPENDIX B
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Form RT02

educational results and achievements of the town’s children and young people at all levels.

Crime and Community safety

We work very closely with local communities, statutory and voluntary agencies to reduce crime and disorder and help people to feel safer within the Borough of Rochdale. To encourage young people and children to play a leading role in their future development and achieve their full potential and aspirations.

d) Contact name Maniza Bi / Sohail Ahmad

e) Contact telephone 01706 860151

f) Contact address and postcode

Deeplish CC, Hare Street, Rochdale, OL11 1JT

g) Email address [email protected]

h) Web address www.deeplishcc.co.uk

SECTION 3 – ORGANISATION FINANCES

a) Have you applied for or received a Township grant before? Yes No

b) If you have answered yes to question a), please give details below

M/02/17 Youth engagement and crime prevention - £250 M/76/16 Computer Science Club Project - £332.52 M/31/16 Improving health, wellbeing and welfare - £1,500 M/04/16 Deeplish Community Centre Website - £500 W/08/16 Health and Well-being - £1080 CE/03/16 Community Engagement Event - £400 CE/23/15 Youth & Faith Community Engagement Conference - £700 CE/07/15 Newsletter - £900 CG/02/15 Deeplish Clean and Green Project - £1200 CG/02/15 Community Engagement - £1350 M/58/15 GCSE Revision Club - £500 M/53/15 Deeplish Community Centre Family Fun Day - £350 M/51/15 Deeplish Community Centre Room Dividers - £700 M/11/15 Stoneyfield Community Engagement Project - £1,200 M/38/14 Deeplish Mother Tongue & Cultural Heritage Project - £500

c) Does more than 50% of your annual base budget/income come from Rochdale Council?

Yes No

If yes, detail below the amounts received and Council Services providing budget/income to your organisation (a copy of your application will be forwarded to your relevant Link Officer for their comments)

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Form RT02

SECTION 4 – ABOUT THE PROJECT AND JUSTIFICATION

Details of the proposed project and what benefits will this project bring for participants, organisation, group or wider community?

This project has been in consultation with users, Community members, local councillors, community groups; purpose

of this is to provide activities for local residents who are isolated, elderly and deprived due to health, disability or

mobility. The project will reduce isolation and provide a platform to improve health and wellbeing.

This Project will also bring More users, improve health and wellbeing and maximize user groups and reduce Health

inequalities. It will also help the Centre to engage with local community and provide positive activities.

We would also like to promote regular weekly sessions for isolated, disadvantaged, elderly members of local

community. This will help us to end social isolation, promote social cohesion and celebrate friendship circles and

enable people to live with increased confidence. This will raise self-esteem, provide isolated people with a better

connections and support with social activities. Through user’s involvement in this project delivery, it will provide

participants a sense of social inclusion, understanding cultures and values and celebrate success. This project has

been planned with users, who are willing to participate and get benefit from this project.

The project will be held at Deeplish Community Centre on a weekly basis and at the end of this project a show case of

work and activities will be held at Deeplish Community Centre.

The project will enable participants to have opportunities to participate in health related activities and exercises

sessions as well as socialise and to get to know each other well. Some of the benefits of social interaction and working

together on this project are that people will become more knowledgeable about different cultures and backgrounds.

This will support them to increase their confidence, strengthen community relations with each other and give them a

stronger voice within local community. The project will support People with mobility needs through community

transport to participate in locally and Centre based sessions.

Project start date 30th Oct 2017 Project completion date

June 2018

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Form RT02

SECTION 5 – PROJECT FINANCES

a) Cost of project £4500.00

b) Amount of grant required £1500.00

c) Amount from other sources £3000

d) Details of other funding

Funder What they may fund Dates of funding decisions

Participants contributions Request from Ward Funds

Refreshments contribution £700.0 Health Open Day / gardening / mental health Seminars

N/A October 2017

e) Breakdown of proposed expenditure relating to the amount of grant required (enclose quotations, cost estimates or extracts from catalogues. At least two quotations will be required for any items to be funded that will cost £1,000 or more to demonstrate value for money).

Expenditure item Cost

1. Exercise Classes x 30 sessions x £25.00 / session –

tutor 2. Refreshments costs for 30 sessions £50 / session for 40

participants 3. Accessible transport for Frail and disabled and blind.

Door to Door Pick up and drop off = 20 journeys / session – Pick up & Drop off including outdoor visits ( 30 sessions x £50.00 per session )

4. Health Open Day- Health Checks and Advice 5. Gardening Project with participants – Plants / Pots /

seeds / Soil / and equipment’s 6. 2 sessions x Mental Health & Meditation Sessions by

specialists

£750.00 £1500.00 £1500.00 £350.00 £250.00 £150.00

TOTAL £4500.00

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Form RT02

SECTION 6 – SUPPORTING DOCUMENTATION

Please supply the following documents when you submit your application. IF YOU DO NOT SUPPLY THESE DOCUMENTS, WE WILL NOT BE ABLE TO PROCESS YOUR APPLICATION. Please tick the boxes to confirm which documents you have attached to this application.

a) Annual accounts and bank statement(s)

b) Constitution/governing document

c) If your project works with children and young people under 18 years old or vulnerable adults, please confirm your organisation has the following in place: Child protection policies and procedures Yes N/A Disclosure and Barring Service (DBS) checked staff and volunteers

Yes N/A

d) Quotes/estimates/extracts from catalogues for proposed expenditure

SECTION 7 - DECLARATION

We, the undersigned agree to:

Abide by Rochdale Township Fund’s Terms and Conditions.

No expenditure being incurred on this project prior to the grant decision being given.

Certify that the information contained in this application is correct and that we are authorised by the organisation to accept these conditions on their behalf.

Use funds, if granted, only as specified in this application, unless receiving authorisation from Rochdale Township Office to make changes.

Send the invoices/receipts for all payments made with this grant along with the completed Project Evaluation Form to the Rochdale Township Office.

Agree to participate in monitoring, auditing and evaluation related to this fund.

Highlight the support of Rochdale Township in all publicity material and agree to Rochdale Council’s use of the organisation’s name and photographs for promotional purposes.

Inform Rochdale Township Office immediately if either signatory leaves the organisation or can no longer fulfil their responsibilities, or someone else takes over responsibility for the grant on behalf of the organisation.

Contact Person Organisation Chair or Treasurer (Different from Contact Person)

Signature Sohail Ahmad Signature Mohammed Saleem

Full name Sohail Ahmad Full name Mohammed Saleem

Position Manager Position Chair

Date 04.10.2017 Date 04.10.2017

Before you send your application to us, please check that you have:

answered all the relevant questions and

enclosed all the information requested: - Annual accounts - Constitution/governing document - Bank statement(s) - Quotations/cost estimates/extracts from catalogues - BACS form

We will return incomplete application forms.

Please send your completed application form to: Rochdale Township Office, Number One Riverside, Smith Street, Rochdale OL16 1XU Tel: 01706 924802 Email: [email protected]

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TTOOWWNNSSHHIIPP PPRROOJJEECCTT BBRRIIEEFF AANNDD

CCOOMMMMIISSSSIIOONNIINNGG FFOORRMM ((22001177//1188))

Township Ref Service Ref

Township Rochdale CE/09/17

Name of Request Originator Link4Life

Project Manager & Ext Leigh-anne Carnall 01706 924840 | [email protected]

Completed by Leigh-anne Carnall Date Completed 09/10/17

AA.. DDEETTAAIILLSS OOFF SSCCHHEEMMEE

Scheme Name & Location Deeplish Multi-Activity Club Deeplish Community Centre 57 Hare St, Rochdale OL11 1JT

Scheme Description (include as much information as possible)

The aim of this project is to provide regular weekly sports, fitness and physical activity sessions to children 8-12 years old for up to 25 weeks. The sessions will be targeting both boys and girls from the local and surrounding areas of Deeplish. Working in partnership with Deeplish Community Centre the Multi-Activity Club will be designed to target young people who do not traditionally engage within sport and physical activity. At Link4Life we deliver a School Sport and PE Programme which is predominantly curriculum based. Although the Programme is successful within Schools, the young people who attend out of school provision are primarily involved in clubs and take part in regular physical activity. Through offering a wider programme in community centres and ensuring choice and variety, we aim to engage more young people in physical activity in turn increasing the levels of physical activity among young people within our Borough. The physical activity guidelines for children and young people aged 5-18 years are at least 60 minutes of moderate to vigorous intensity physical activity every day, incorporating muscle strengthening activities on at least 3 days a week. Around two in ten children aged 5-15 years meet the recommendations. Therefore we have 80% of young people who do not; the multi- activity club will aim to target those young people who do not traditionally engage within physical activity. We will offer a weekly (term time only) Programme of Sports, Physical Activity and Arts and crafts, to ensure we attract the correct audience we will promote as a multi-activity club. The multi-activity club will contribute to improving the statistics and ensure focus on physical wellbeing. The coaching staff who will deliver the project will be from the Casual Community Coaching Team within Link4Life and volunteers from Deeplish Community Centre will assist with managing and delivering the sessions as well as engaging with the local community to communicate information about the club. Partners involved in the programme include (but not limited) Schools, Community Centres, Youth Services, INT Health and Wellbeing Team, Children’s Emotional Health and Wellbeing Coordinator, Healthy Lifestyle Team etc.

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APPENDIX C
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To ensure we engage participants we will promote the programme utilising the Link4Life social media platforms, fliers, posters, e-newsletters and through existing groups and forums at Deeplish Community Centre. The multi-activity club will run in the evening each week for 1 ½ hrs. The session will not conflict with any other programmes or sessions and will tie in with Mosque where children can visit the multi-activity club once they have been. Following on from a successful summer playscheme at Deeplish Community centre, which Link4Life supported, there is a need for more junior activities in the evening. Over 50 young people attended activities over the summer and many parents and children expressed an interest in continuing sessions throughout the term.

Desired Outcome (what is required by the scheme)

Contribute to reducing the number of children at Year 6 outlined as Overweight or Obese. Improved emotional health & wellbeing of participants Increase children’s self-esteem, communication skills and collaborative approach to sport and physical activity To provide a continued pathway of sport and physical activity outside of traditional clubs Bring together young people from different backgrounds To keep children engaged in positive activities in the evenings.

Township Priorities Met People

Land Owner Rochdale Council

Public Consultation No

Proposed Source of Funding Township Revenue

BB.. EESSTTIIMMAATTEE

Assumptions made during preparation of estimate

All costs are based on targeted number of children engaging with the programme along with supplier costs. Room hire at the community centre will be given in kind and existing sports kit will be used to deliver the sessions

Risks that may change estimate

All costings are based on current supplier costs for arts & crafts, there could be a potential increase before sessions start.

Total Estimated Fees £1500

Total Estimated Works Costs £1500

Total Cost £1500

Amount Approved by Township £ Cost Code

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CC.. TTIIMMEESSCCAALLEESS

Estimated Start Date 31 October 2017

(start date subject to commissioning within three months of application)

Evidence

Fliers Social Media Posters E-newsletters Bookings of coaches and community centre rooms

Completion Date 23 May 2018

Evidence

All Children who attend the programme will complete a consent form, which will capture data such as gender, ethnicity & postcodes. Registers will be used to track attendance and allow us to report how many children attend the programme in total. Case studies Photos Young people attending will receive information on continued participation in sport through either at local clubs, community sessions or family events.

DD.. AAUUTTHHOORRIISSAATTIIOONN

I have read the terms and conditions provided with this form and agree to the funds being allocated as approved at Committee

Date Committee Approved Scheme

Signature of Head of Service Donna Livesey Date 9/10/17

Signature of Townships & Communities Manager

Date

Signature of Township Chair Date

KEY

To be completed by whoever receives the original proposal

To be completed by Service/Provider after discussion with the Township Office

To be completed by Township Councillor/Officer