Small Grant Under £250 Application Form

GRANT APPLICATION FORM

SMALL GRANT UNDER £250

For training/education/meetings please use the following link: Click here to apply

Please only complete this form to request funding for expenditure under £250 only. This form is ONLY to be completed where there is not already a grant approved.

PLEASE NOTE:
- The charity will not fund anything retrospectively including anything that has already been ordered, purchased, installed, or completed. Please ensure you do not spend any money prior to getting approval for a grant first.
- We need to receive the expenditure within two weeks after an event/course or four weeks for a project.
- A maximum of two reimbursements or direct invoices only (we cannot receive a recharge from UHBW if an order goes through a Trust cost centre).
AUTHORISATION

Grant applications will only be considered when they have been seen and accepted by your line manager and evidence to support the costs has been attached. Missing or incorrect information will cause a delay to a funding decision and may not be granted.

Line managers can provide authorisation via emails from UHBW email accounts or can be uploaded to this application form in place of hard copy signatures.
TIPS TO HELP WITH COMPLETING THE FORM
- Read through the application form first so that you are aware of what information you will need to complete it.
- You can save the form which will email you a link so you can come back to it later.
- Keep the application simple, include key points and ensure your figures add up.
- Please note we may not be able to further consider your application if there is insufficient information provided so please use these tips and examples under the questions to help you.
- If using acronyms, please explain what they are for the first time so that we know what they mean
- Ask someone who isn’t involved with the project/funding request to read the application - does it make sense? Can they identify the key points?

USEFUL LINKS

Small Grant Application Guidelines
Read the Grant Application FAQ's
Visit the grants webpage

If you are unsure of anything or have any further questions about the application, please do not hesitate to get in touch with the grants team at grants@bwhospitalscharity.org.uk.

Section A: Grant details
SECTION A

GRANT DETAILS
Date of application*

DayMonthYear
Total amount requested £*
This must be UNDER £250. If over £250, please see our other grant application forms.
Hospital:*
Division:*
Speciality/area:*
Project title/funding request:*
A short one line project title/funding request e.g. 'salary for physiotherapist' or 'play equipment' or 'refurbishment of staff room, etc. We do not need a full description at this point.
FUNDING PROGRAMS
The charity has four programs where ideally our grant-making should be focused.

Please indicate which funding program your project/funding comes under (more than one program may be relevant for your application).

For more information about these programs, read about what we fund on our website.
Please tick one or more of these funding programs that seem most relevant to your application:*

Healing environments - Calming environments designed with patients and families in mind, can lower patient anxiety and improve clinical outcomes.Healthcare for all - We know that not everyone has the same access to healthcare in our hospitals. We will support projects that enable access for minoritised communities and people who experience barriers to treatment in our hospitals.Innovation and change - We’ll fund the most innovative and emerging technologies and treatments that can change or even save a patient’s life that wouldn’t otherwise be available. We will collaborate on new ways of working that help transform patient care.Older people - Nearly two thirds of the patients in our hospitals are aged over 65. We want to provide funding that not only transforms the experience they have within our hospitals but helps support rehabilitation, reduce anxiety, distress and loneliness.
GRANT APPLICANT CONTACT DETAILS
Please ensure that your details are correct so that we can contact you.
Grant applicants name:*

First nameLast name
Position/Job role:*
Email address:*
Phone number:
LINE MANAGER CONTACT DETAILS
Please ensure that you have received support for this application from your line manager. We will require a written email of support from the line manager.

This can be emailed via a UHBW email address to grants@bwhospitalscharity.org.uk stating the application and their approval. Alternatively, you can upload a screenshot or document of approval from your line manager. Failure to provide your line manager's approval will mean we cannot proceed with the application.
Line manager's name:*

First NameLast Name
Position/Job role:*
Email address:*
Phone number:
Has a written email of support been sent to the BWHC grants team?*

Yes, I confirm that the line manager has already sent an email of approval to the charity grants team.No, I will upload the written support in this application.
Please upload your written evidence of support from the line manager stating the application and their approval.

This could be a jpeg, png, pdf, doc. Emails need to be a screenshot and saved as one of these files.
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Section B: What is the funding for?
SECTION B

WHAT IS THE FUNDING FOR?
This section is for you to tell us more about your request.
What is the funding for?*
Please describe what the funding will be used for. e.g. ‘This is a subscription for a publication for the department which is an educational/information tool for staff to keep up with developments and news in our service.’

Section C: Intended impact of the funding
SECTION C

INTENDED IMPACT OF THE FUNDING
This section is for you to describe the impact that this funding will have.

It is important for the charity to be able to demonstrate the effectiveness of its funding to donors, trustees and the public as a whole.
Who will benefit the most from this funding? *
Please explain who will benefit from this funding and how it will make a difference. e.g. ‘All the staff in the department will benefit as this publication will be available for all to read. It will provide additional learning and information for staff and enable them to keep up to date with latest developments in the service. Ultimately, patients will benefit as the knowledge and information staff glean will help with treatment of patients.’
How many people will benefit from the project/funding?*
Please detail the numbers of those benefiting from this funding. It will help us to evaluate impact quantitatively, hence why we are asking for numbers of people that will benefit e.g. ’25 staff in the department will have access to the publication’.

Section D: Additionality
SECTION D

ADDITIONALITY
This section is for you to explain how this project is not core NHS provision.

Please note, if this is something that would normally be funded by the NHS/Trust, but the Divisional/Trust budgets cannot accommodate this, then this does not mean that this should be funded by Bristol & Weston Hospitals Charity as it would be considered standard provision and not over and above what the NHS/Trust should provide.
How is this project NOT considered core NHS provision?*
Please explain why this project will not be funded by the NHS or UHBW Trust. e.g. ‘Subscriptions are not considered core and are additional to the standard provision for staff and therefore not included in Divisional budgets.

Section E: Costs and Evidence
SECTION E

COSTS
This section is for you to detail what costs you would like charity funding for.

Only complete the applicable sections. Please include amounts with VAT.
1. ITEM COSTS

Please provide a breakdown of the item costs associated with this application.

To be completed for items such as fees, purchases for department, etc. You must upload evidence below to support these costs such as quotes, invoices, itemised receipts, emails.

Please note, we cannot fund catering costs alone.
TOTAL COST OF ALL ITEMS £
Upload your evidence to support all the costs listed above. Unless evidence of all of the costs is provided, we cannot proceed with your request:

This could be a jpeg, png, pdf, doc, xls, csv, zip. You must include itemised evidence of costs such as quotes, invoices, emails with costs detailed from company/organisation. Emails need to be a screenshot and saved as one of these files.
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How many people will require travel and accomodation?
FLIGHTS
Please note, only economy class will be considered.
Departure location:
Arrival location:
Cost per person £
TOTAL FLIGHT COST £
TRAIN
Please note, First Class travel will not be considered.
Departure location:
Arrival location:
Cost per person £
TOTAL TRAIN COST £
TAXI
We accept that this may be approximate. You can search on the internet to work out an estimation.
Departure location:
Arrival location:
Cost per person £
TOTAL TAXI COST £
MILEAGE
Please detail the mileage to and from the event as well as the mode of transport.

Current mileage rates are:
Car: 45p per mile (5p per mile for each additional passenger)
Motorcycle: 24p per mile
Bicycle: 20p per mile
Departure location:
Arrival location:
Cost per person £
TOTAL MILEAGE COST £
PARKING COSTS
Location:
TOTAL PARKING COST £
ACCOMODATION COSTS
A maximum of up to £100 per night will be allowed for overnight accommodation.
In central London or overseas, up to £150 per night may be requested.
Number of nights required:
Location:
Cost per person £
TOTAL ACCOMODATION COST £
TOTAL AMOUNT £*
Total amount of item costs plus travel and accomodation costs. Please ensure that ALL costs are included at the time of applying.
Upload your evidence to support the costs above including all items plus any travel and accomodation costs. Unless evidence of ALL the costs is provided, we cannot proceed with your request.*

This could be a jpeg, png, pdf, doc, xls, csv, zip. You must include itemised evidence of costs such as quotes, invoices, emails with costs detailed from company/organisation. Emails need to be a screenshot and saved as one of these files.
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Are these costs estimates or the final price?*

All costs are the final priceThe costs are estimated amounts
Please note, for estimated costs, if the application is approved, the charity will include a reasonable ‘contingency’ amount to cover potential rises that may occur between the time of application and request for reimbursement.
PAYEE BANK DETAILS
Please detail the account you wish your grant request to be paid into. Please ensure that you check that you have given the correct details to avoid any delays.
Account name:*
Sort code:*
Account number:*

Submit Your Application
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