Kirklees Development Fund Inclusion Grant – Application Form

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Kirklees Development Fund

In partnership with Disability Sport Yorkshire

Inclusion Grant – Application Form

Please complete this application form in full, referring to the guidelines for applicants

Name of organisation
Address for CorrespondencePostcode:

Tel No: Email:

Organisation ContactName:

Position:

(Chair, Secretary, Treasurer, committee member)

Tel No:

Email:

Organisation Contact

In case of above contact being unavailable

Name:

Position:

(Chair, Secretary, Treasurer, committee member)

Tel No:

Email:

Briefly describe your organisation
Describe what you want the funding forGive details of the activity, how often it will take place and who will be involved. Outline how you plan to sustain the activity after 12 months
Project detailsStart Date: End date:
Venue Address:

How often will participants be involved in the activity:

Anticipated number of regular participants:

Details of expenses

Please refer to the guidelines for allowable expenses

Amount £
Total£
Details of income e.g. member contributions, fundraising etc.

Remember we will only fund activities that can become sustainable beyond 12 months

Amount £
Total£
What best describes your activities?Number

of persons

How many people in the following groups will benefitNumber

of persons

ActivitiesOlder people
Maximising independenceCarers
Social clubPeople with visual impairment and/or physical disability
Healthy living activitiesPeople with learning disability
Broadening experiencePeople with mental ill-health
Green gymPeople living with HIV/Aids
Luncheon clubPeople with long term ill-health
VolunteeringOther (please give details in the box below)
Other details:
Please indicate how many people in the following will benefit from the project?

Please note that organisations are expected to monitor access from the following groups

BackgroundNumberBackgroundNumber
BritishCaribbean
IrishAfrican
EuropeanOther Black
White OtherWhite/Black Caribbean
BangledeshiWhite/Asian
IndianWhite/Black African
PakistaniMixed Other
Asian OtherChinese
Gender
MaleFemale
Please return this form:

By email: fhall@fdso.co.uk

By post: Disability Sport Yorkshire

Denhale Active Recreation Centre

Denhale Avenue

Wakefield

WF2 9EF

This section is for office use only
Amt requested£Divide by no of sessions p.a.Divide by no of hours per sessions Divide by average No of participants= Unit cost£
Total Cost£Divide by no of sessions p.a.Divide by no of hours per sessionDivide by average no of participants= Project cost£
Amount requested:Amount approved:
Conditions of grant:
Approval of Disability Sport Yorkshire

Project Officer

Signature……………………………………………………………

Date…………………………………………………………………..

Approval from Community Partnership

Performance and Investment Manager

Signature……………………………………………………………..

Date…………………………………………………………………….