Barnby Dun Community Association ( Welcome to the ‘Old School’)

BARNBY DUN COMMUNITY ASSOCIATION

COMMUNITY CHEST – APPLICATION FORM

1 Name of your group or organisation

(Please tell us the name of your organisation or group as it appears on your governing document, eg: constitution.

This name must match your bank statement and accounts)

2 Name of your project

(Choose a short title that describes the activities of your project)

3 Contact details

(Please give us the name of one person we can contact should we have any questions about the application)

Main contact

Name

Position

Address

Daytime Telephone No

E-mail address

Please confirm that you or any member of the group will not personally gain from the project

4 Please tell us about your organisation

(Tell us what your organisation actually does and who it involves)

5 Tell us about your project

(Tell us what the grant will fund, why the project is needed and who will benefit from it)

6 When do you plan to start your project?

(The project must be completed within a maximum of 12 months of receipt of a grant)

7 Project costs and grant needed

Item & Description	Total Cost	Grant Requested

8 Bank Details

(We pay successful applicants by cheque so need to know the name of your bank account)

Name of Account

Checklist

Please ensure you submit all the necessary documents to avoid any delay in progressing your application:

• A signed and dated copy of your organisation’s constitution / governing document which includes an appropriate dissolution clause.
• A copy of your most recent signed accounts (less than 12 months old) which are in the name of your organisation as stated on your governing document.
• Copies of quotations for items to be purchased.

• We will use any grant for exactly the same purpose set out in this application.
• We will not sell or dispose (get rid) of any assets which we have bought with the grant without first receiving your agreement in writing. If we sell any assets, we may have to pay you part of the money we receive for them. The amount we repay will be in direct proportion to the share of the project costs that came from you.
• We will not buy or order any goods or services for which this application is made before we receive the offer letter confirming the grant.
• We will acknowledge your grant in our annual report, our Chair or Secretary's report at our Annual General Meeting, the accounts which cover the period of the grant and in any publicity material we produce about the project.
• We will spend the grant within one year of the date of the offer letter.
• If we do not spend the entire grant, we will return any unspent amount to you as soon as possible.
• We will send you copies of receipts relating to expenditure of the grant, as evidence that the grant has been spent for the purpose in which it was given.
• We understand that you will not increase the amount of the grant if we overspend.
• You may reclaim all or part of the grant, in the following circumstances:
• If we fail to keep this contract in any way.
• If the application form was filled in dishonestly or the supporting documents gave false or misleading information.
• If we fail to complete the project within one year of the offer letter.
• If we close down, become insolvent, go into administration, receivership or liquidation
• If our group closes down we will not sell or dispose (get rid) of any assets without first receiving your agreement in writing.

The box should be signed by the main contact person named in question 3

Signature      Date

Signed by the chair, secretary or committee member (who is not the main contact above), who agrees to act as Second Contact for the project named in question 2.

Signature      Date

Please return your completed form to:

Barnby Dun Community Association

The Old School

Top Road

Barnby Dun

Doncaster

DN3 1DB