MULTIPLY Application Form 24/25

Lincolnshire Multiply Champion Application Form 2024/2025

We are delighted you have expressed an interest in becoming a Multiply Champion. To help us progress your application, please complete the details below:-

Please follow the link for:- Multiply Champions Application Guidance

Please follow the link for:- Privacy Statement

For existing Multiply Champions: if you have an interest in continuing your involvement in 2024 / 2025, please email multiply@lincolnshire.gov.uk. We will then forward you the link to the specific application form for existing Multiply Champions. The deadline of 31st October 2024 for applications also applies.

Please be aware, the deadline for submitting an application to become a 24/25 Multiply Champion is Thursday 31st October 2024.

Are you an employer or a Community Organisation (Tick the appropriate box)?

EmployerCommunity Organisation

Part 1: Details for Business / Community Organisation

(complete boxes that apply)

Company / Organisation name:

Company / Charity number / Sole Trader / Social Enterprise / CIC etc:

Your Lincolnshire Operational Address including postcode:

Website / Facebook Page (if applicable):

Business Sector:

Workforce size needs to be a total of 5+ including employees / volunteers. Please detail below:

Employees:

Volunteers:

Main contact name:

Position:

Telephone number:

Email address:

What are the numeracy challenges within your Business or Community Organisation?

Details of your Multiply Champion Lead(s) - (they do not need to hold a senior position within your organisation)

How many Multiply Champions will your organisation have?

Their name(s):

Their position(s)in the Company / Organisation:

Telephone number(s):

Email Address(s):

Their name(s):

Telephone number (s):

Their position(s) in the Company / Organisation:

Email address(s):

How will you utilise the Multiply Champion grant? Give details of proposed activity and how the grant will support this (minimum of 350 words).

How many individuals do you hope to positively impact with your proposed activity?

Please give details as to how you will ensure your Multiply Champion will:- Attend the twice yearly Multiply Champion Link and Learn Networking meetings. Provide feedback, success stories and a case study (if requested) of the activity undertaken. Complete any required online surveys.

Part 2: Supporting Documents Checklist

Where applicable, please submit the following documents with your full application

- Recent Bank Statement (from the last 6 months)

Please confirm if this has been included (Type YES/NO) & Add supporting comments if necessary:

- Last set of audited accounts (please state if not available and indicate reason why):

Please confirm if this has been included (Type YES/NO) & Add supporting comments if necessary:

- Signed constitution (if Community Organisation):

Please confirm if this has been included (Type YES/NO) & Add supporting comments if necessary:

Part 3: Declaration by Applicant

By submitting this application, you fully understand and accept the statements below. We can only accept applications from an authorised representative from the business or authorised Community Organisation signatory (as detailed in the Constitution).

1. Fraud statement:

I. I have read and understood all documents about this scheme, including all information about eligibility

II. I am providing true, accurate and complete information

III. I understand that by giving wrong or incomplete information which I know to be misleading, I may be committing a criminal offence and could face prosecution

IV. I understand we will investigate all applications where it suspects fraud

V. I understand that we will check all the information that I provide and may ask for further details, if necessary

VI. I understand that I must pay back any money I receive to which I am not entitled

2. I certify that:

I. I have read, understood and agree to be bound by the conditions of this grant scheme as detailed in the guidance notes or other supporting documentation. To be completed

II. I understand and agree that if this application is successful, the organisation or individual will be bound to use the grant exclusively for the purpose specified in the application.

III. The information contained in this grant application is true and accurate and complete in all respects.

IV. I can confirm that I am either the Business Owner, an authorised Business signatory or authorised Community Organisation signatory (as detailed in the Constitution), and I have due authority to submit this application on behalf of the organisation.

3. I understand that:

I. The acceptance of this application by Lincolnshire County Council does not in any way signify that they have agreed this grant will be awarded.

II. The full application may be declined, and that the decision of Lincolnshire County Council is final and that there is no appeal process.

III. Any grant paid will become immediately repayable in the event of any material inaccuracy or submission of false information.

Please confirm you have read, understood and agree to the terms of the declaration by submitting this form.

Full Name:*

Position within Organisation:*

Date:*

Select to confirm the following:*

You have opened, read and understood the privacy statement located on the first page of this application formYou have read and understood the fraud statementYou are authorised to apply for, and accept, this grant on behalf of the business / community organisation named in this applicationYou will repay any funds you receive if it later turns out you were not entitled to receive themYou understand the need to attend the twice yearly Multiply Champion Networking meetings

To ensure we reach as many organisations as possible, we would like to capture success stories, and real-life experiences. Please confirm you are happy to share this information and complete our online evaluation surveys

Yes I confirm