Climbers Against Cancer Grant Application

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PLEASE NOTE THE FOLLOWING

Application assessment
Decisions by the Climbers Against Cancer (CAC) to fund projects and programmes of work, are subject to a formal decision-making process. We will assess your project application on the basis of this form and any supporting documents you submit, which are designed to give us all the information we need about your organisation, the project you are applying for and the proposed budget.
We will pay particular attention to how your project fits within and assists the delivery of our charitable purposes. For more information on this please visit www.climbersagainstcancer.org.
If we are not able to make a final decision based on the information provided, then we may contact you for further information.
You will be notified of our decision formally in writing. If your application is not successful, we will provide you with feedback at the same time as the decision or as soon as possible afterwards.
Please note that any expenditure that you incur or commit to prior to formal notification is entirely at your own risk.

Data
By signing this application form, you agree that CAC can use the information provided in this application form and other supporting information you provide to us to:
• assess your application and decide whether to award your project grant funding
• hold on file and use for statistical and analysis purposes

Promotion
If we offer you a grant, we may publish information about your organisation and the activity we have funded, including the amount of the grant. This information may appear in media releases, in our print and online publications.

You should therefore tell us what if any of the information you have provided is confidential and provide reasons for this - see section 16.h.

In dating, signing and submitting this application form you confirm that the information provided is correct and that any grant awarded will be used exclusively for the purposes described, unless variations are agreed in writing with CAC.

Please give a descriptive name to your project*

Date of application*

YYYY/MM/DD

Name of your organisation *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact name and title*

Phone Number*

Country CodeArea CodePhone Number

Email*

example@example.com

Legal status of your organisation*

Brief description of your organisation's purpose & activities

Project start date

YYYY/MM/DD

Project end date

YYYY/MM/DD

Project location(s)

Country

Project category (tick all that apply)

What is the project rationale (100 words max please in simple language!)

0/100

What is the project trying to achieve (100 words max please)

0/100

List the key activities involved

0/100

List all the partners in the project

0/100

Describe your project in more detail (1000 words max please)

0/1000

eg. Objective: to raise awareness about post-op care, Preferred outcome: an increase in number of attendees, Indicator: number of attendees per session per week/month/year, Success criteria: An increase of 100 attendees by year n+1 *

	Objective (as in section 6)	Outcome (changes you expect to see)	Indicator (how you will measure it)	Success criteria (quantitative or qualitative target)
1
2
3
4
5
6

Please set out the key milestones for your project.*

	Milestone	Action	Date (dd/mm/yyyy)	Comments
1
2
3
4
5
6

You must identify at least one risk*

You must meet at least one aim*

	Charitable aim	In what way
1
2
3
4
5
6

Please provide amounts in GBP (£ sterling)*

	Amount	Comment
Total project cost (incl. all match funding)
Amount requested from CAC
Amount of overall funding already secured

List costs*

Total expenditure (GBP)*

List income*

Total income (GBP)*

Total in-kind support (GBP)*

a. Will the project go ahead without CAC funding?

YesNoUnsure

Please provide details as appropriate

b. Is there a date that you need a funding decision by?

YesNoUnsure

If yes, please specify

c. Are you, as a representative of the applicant, or your organisation, associated with CAC in a formal or informal capacity?

YesNoUnsure

Please provide details if appropriate

d. Have you discussed your application with any of CAC's Trustees or Staff?

YesNoUnsure

If so, who?

e. How did you hear about the availability of CAC funding?

f. Has your organisation previously applied for CAC funding?

YesNoUnsure

g. Does the recipient organisation have a bank account, with two separate signatories (registered in the name of the application organisation) into which a grant can be paid?

YesNoUnsure

h. Is any of the information you have provided to us confidential?

YesNoUnsure

If so, please indicate which information and why

i. Please state whether you are able to produce the following documentation :*

	Yes	No	Unsure
Copy of the most recent audited accounts OR a statement of the organisation's turnover, profit & loss/income & expenditure and cash flow for the most recent full year of operations where this information is not available in audited form
Copies of the organisation's public liability and employer's liability insurance policies
Volunteer policy including assurance of appropriate Disclosure & Barring / Criminal record checks for volunteers
Health and safety policy or equivalent
Equality and diversity policy or equivalent
CSR or Climate/Environment or Sustainability Policy
A copy of the organisation's governing document (ie. Articles of Association or your constitution) if applicable (charities and community groups)

If any item of documentation would not be available on request, please state the reasons here.

Anything you would like to add?

If you have any supporting documentation you wish to include, please upload it here, preferably in pdf format.

Climbers Against Cancer Funding Application Form

1 - Project title

2 - Applicant

3 - Project outline

4 - Overall project purpose

5 - Project objectives

6 - Project activities

7 - Project partners

8 - Project details

9 - Measurable impacts and project outputs

10 - Project plan

11 - Project risks

12 - How does your project meet the aims of CAC?

13 - Project financing

14 - Financial breakdown

15 - In-kind support

16 - Due diligence