EXAMPLE FINAL Yorkshire Funders Common Application Form

1. Name of Organisation/Group*

2. Address*

Street Address

Street Address Line 2

City/Town/ VillageWebsite/social media

Postcode

3. Details of contact person*

TitleNamePosition

4. Main contact number*

5. Second contact number

6. Email*

example@example.com

7. Do you have any communication needs? (e.g. BSL, large print)

By entering information in the box above you give your consent for [name of funder] to hold this information. See Privacy Notice for more details.

8. Please select your organisational structure*

Informal group/community groupRegistered charityCharitable Company limited by guaranteeCommunity Interest Company (CIC) Limited by guaranteeCharitable Incorporated Organisation (CIO)Community Benefit SocietyOther

9. If you selected other, please describe

10. Please provide registered number(s) (charity/company etc)

11. Please briefly tell us the aims of your organisation and what you do (up to 300 words)*

0/300

12. Please tell us the number of:*

	Number
Trustees/directors/committee/governing body members
Full-time and part-time equivalent staff
Volunteers (excluding those listed above)

13. Please describe the project, service or activity you are asking us to fund (up to 500 words)*

0/500

14. Why is this project, service or activity needed? (up to 300 words) *

0/300

15. Who will benefit from this project, service or activity? (up to 100 words)*

0/100

16. How many people do you think will benefit from your project, service or activity? *

17. Where will your project, service or activity take place: region, local authority, city, village, ward? *

18. What difference will your project, service or activity make to the lives of those who take part? (up to 300 words)*

0/300

19. When do you expect the project, service or activity we are funding to start?*

Date

20. When do you expect the project, service or activity we are funding to end?*

Date

21. How will your project, service or activity help to meet our aims/priorities?*

0/100

22. About Money - please tell us what your project, service or activity will cost

	Amount
Total project/service/activity cost
How much are you asking us for?

23. If you are asking for less than the total project/service/activity cost, please tell us where the rest of the funding is coming from and when you hope that will be secured

24. Budget for project/service/activity*

	Item	Amount	Description
1
2
3
4
5
6
7
8
9
10
Total

25. Please tell us what you think your income will be for the current financial year*

26. Please tell us what you think you will spend in the current financial year*

27. Is there anything else you want to tell us about your finances going forward?

28. Amount of current unrestricted/free reserves*

29. Does your organisation have a bank account?*

YesNo (please describe below who will hold the funds you have requested)

30. If your organisation does not have a bank account, please explain who will hold the funds you are requesting

31. Name of bank account

32. Name of bank/building society

33. Bank account number

34. Bank sort code

By signing this for you are confirming 1) You are authorised to make this application on behalf of your organisation 2) The information provided is accurate and true 3) Your application has been authorised by the governing body of your organisation

Please upload these supporting documents 1) Most recent, audited or authorised statement of accounts 2) A copy of a recent bank statement 3) A copy of your organisation’s Safeguarding Policy if your work involves children and young people or vulnerable adults 4) A copy your governing document/constitution 5) Include photos and any additional documents you feel show the work you do

Yorkshire Common Application Form