Kirklees Development Fund Inclusion Grant – Application Form
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 Correspondence | Postcode: Tel No: Email: | |||||
| Organisation Contact | Name: 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 for | Give 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 details | Start 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 benefit | Number of persons | |||
| Activities | Older people | |||||
| Maximising independence | Carers | |||||
| Social club | People with visual impairment and/or physical disability | |||||
| Healthy living activities | People with learning disability | |||||
| Broadening experience | People with mental ill-health | |||||
| Green gym | People living with HIV/Aids | |||||
| Luncheon club | People with long term ill-health | |||||
| Volunteering | Other (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 | ||||||
| Background | Number | Background | Number | |||
| British | Caribbean | |||||
| Irish | African | |||||
| European | Other Black | |||||
| White Other | White/Black Caribbean | |||||
| Bangledeshi | White/Asian | |||||
| Indian | White/Black African | |||||
| Pakistani | Mixed Other | |||||
| Asian Other | Chinese | |||||
| Gender | ||||||
| Male | Female | |||||
| 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 session | Divide 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……………………………………………………………………. | ||||||||