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Community Response Fund 2021Application FormPlease read the Guidance Notes before you complete this form.
Section A) About your organisation1) Contact DetailsOrganisation Name:Contacts Lead Contact Secondary Contact
Name:
Tel Number:
Mobile Number:
Email address:
Address(inc. postcode)
2) What type of organisation are you?(tick all that apply) Organisation NumberUnincorporated Association / Community GroupCompany Limited by GuaranteeRegistered CharityCharitable Incorporated OrganisationCommunity Interest Company Community Benefit Society Cooperative SocietyOther (please specify)
3) Is your organisation a member of Salford CVS? Yes: No:
All applicants must be existing full members of Salford CVS. 4) What is your organisation’s annual turnover? (Max £2m) £5) Are you applying in partnership with another VCSE organisation or organisations? Yes*: No:
*If you answered Yes, please complete and enclose Page 1 only for each additional partner.Section B) About your project
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6) Project Name:
7) Please provide a short summary of your project (50 words max)
8) Please select the community that best describes who will benefit from your project
Tick all that apply
Black, Asian and Minority Ethnic people
Disabled people
Those economically most disadvantaged
Other
9) In plain language please describe who will benefit from your project
10) Approximate number of unique beneficiaries / month
11) Which funding priorities does your project addressTick all
that apply
Provision of food to discrete geographic communities/communities of identityAddressing digital exclusion
Provision of health and wellbeing support
Provision of economic / welfare support
Other
12) Please describe the level of need (with evidence) for this project (150 words max)
10 points
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13) In practical terms what will your organisation deliver through this project. inc. when, how often, who (staff/vols etc. (350 words max)Please also describe the role of any project partner organisations.
10 points
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14) When will your project?
Start:
Finish*
* all project spend is expected to be complete by September 30th 2021
15) In which areas of Salford will your project be targeted? (Please tick all that apply) Salford city-wide Irlam Swinton South
Barton Irwell Riverside Walkden North
Boothstown and Ellenbrook Kersal Walkden South
Broughton Langworthy Weaste & Seedley
Cadishead Little Hulton Winton Claremont Ordsall WorsleyEast Salford Pendlebury
Eccles Swinton North
16) What might you measure or assess to determine the outcomes and impact of your project?
10 points
Project Outcome How measured or assessed
Further details of your approach to evaluation e.g. understanding your baseline, measurement tools etc.
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Section C) Maximising the benefits for SalfordWe expect all projects to help contribute towards making Salford a better place for all.
17) Paying the Living Wage – if you have staff Yes: No: N/A:
Do you pay all your staff the at the Living Wage Foundation’s minimum rate of £9.30/hour?Is your organisation registered with Living Wage Foundation as a Living Wage Employer?Would you like further info on becoming a Living Wage Employer?
18) Supporting local businesses and VCSE sector organisations In delivering your project how will you prioritise buying of goods and services from local independent businesses / VCSE sector organisations?
5 Points
19) Added social-value What other social, environmental or economic benefits will be delivered through your project? (e.g. volunteer opportunities, enhanced greenspace, training opportunities etc.)
5 Points
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Section D - About the money20) Please give details of your project budget 10
Points
Description of item Breakdown of calculations Item cost Amount
requested
£ £
£ £
£ £
£ £
£ £
£ £
£ £
£ £
£ £
£ £
Total cost of project over next 6 months: £
Total amount requested from this fund: (£10,000 max) £
If applicable, where is the rest of the money coming from?
Source of funding Amount Funding Secured?
££££
Please retain all financial records.Salford CVS reserves the right to audit your project expenditure.
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Section E) Policy check21) Please confirm you have the following policies in place? tick all that apply a) COVID-19 specific risk assessment – summarise the actions your organisation has implemented to ensure that any activities being delivered are COVID-safe
b) Health and Safety policy e) Wider Risk assessments(if applicable to project)
c) Equality/Diversity Statement or Policy
f) Safeguarding Children policy(if applicable to project activities)
d) Public Liability Insurance(Cost can be included in budget)
g) Safeguarding Adults policy(if applicable to project activities)
Please enclose: Please tick to confirm
ONLY If applicable to your project activities
Safeguarding Children policy if working with childrenSafeguarding Adults policy if working with vulnerable adults
ONLY for food preparation / cooking projects
Food hygiene rating certificate for venue
Food hygiene certificate for lead cook(s)
ONLY for partnership applications
Completed Page 1’s (of this form) for each additional partner (also see guidance notes)
DeclarationWe have read and understood the Terms and Conditions and confirm we will adhere to these conditions if our application is successful:
Name (signature not req)Role: Date:
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Please return your completed application by email to: [email protected] in Word or PDF format (no scanned PDFs). Closing Date: 12:00 noon, Monday 15th March 2021
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