Community Impact Fund

Application form

Please complete the application form below. You can't save your application, so you will need to complete this form in one go.

We have tried to make the application form as easy as possible to fill in. If something is not clear, please contact the Community Involvement & Investment team.

About you and your group/organisation

Name of group

Address

Postcode

Contact name

Telephone number

Email address

What is your role/responsibility within the group?

What does your group/organisation do?

Please tick this box to confirm that your group/organisation is constituted

I confirm that my group/organisation is constituted.

Upload a copy of your latest annual accounts/report. If your group or organisation is new, a draft or income and expenditure forecast will be sufficient.

Your file must be a PDF or Word document.

Upload a copy of your public liability insurance details

Your file must be a PDF or Word document.

Upload a copy of your employers' liability insurance details

Your file must be a PDF or Word document.

Please explain if/why any of these documents are not available

About your project

Project name

Project location

Project start date

Date

Project end date

Date

Which of our key themes does your project align with?

Employment and skills

Financial capability

Digital inclusion

Health and wellbeing

Project description

Please tell us as much as you can about the project/activity for which you are requesting financial support. How did you come up with the idea for this project?

How do you know that your project or idea is needed locally?

For instance, have you consulted the local community about the project? What was the result?

How many GreenSquareAccord customers will the project impact?

Are you targeting a specific beneficiary group or segment of customers? Please include information about how you could evidence this.

What are your anticipated project outcomes?

Please explain why the project is taking place – who in your community will benefit and what will change/improve for them as a direct result of the project?

How will you let the wider community and public know about the project work you are doing and how will you get them involved?

For instance, community newsletters, posters, via local social media groups.

Funding details

Total cost of the project

How much are you applying for?

Please note, the maximum you can apply for is £2000.

Which other organisations are supporting your project, financially or otherwise?

Please provide details of stakeholders and what they are contributing.

What will this funding pay for?

Please break this down as much as possible for us.

How much of the funding is already secured?

What would happen if you did not receive funding from GreenSquareAccord?

Confirmation statement

Please confirm this statement

I confirm that the information given in this application is a true statement and that I am authorised to make this application on behalf of the group/organisation.

Signed

Date

On behalf of (group/organisation)

Privacy statement

We need your consent to store and process your personal information to review your application. Your personal information will be processed in line with our privacy notice. We will not share your personal details with any third parties.

Consent for storing and processing submitted data

Yes, I give permission to store and process my data

Disclaimer

As funds are limited not all applications will be successful and the judging panel's decision will be final. Completing this application form is not a guarantee that you will receive funding. Please do not allocate money to a project until you have received confirmation that it has been approved.