Southmead Grant Application

Southmead Expenditure Request Form

Please complete this form to request funding for charitable expenditure.

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 expenditure first.
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.
- 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?
If you wish to draft an application, there is a 'Save and Continue Later' option at the end of the form, HOWEVER this will only allow you to save one draft at a time (everytime you save a draft, it will overwrite what you did previously). If you wish to make more than one application and save drafts, please contact us at grants@bwhospitalscharity.org.uk for a draft form before using this platform.

If you need any help completing this form please contact the Grants team at grants@bwhospitalscharity.org.uk

- SECTION A
  
  REQUEST DETAILS
- Project title/funding request:
  A short one line project title/funding request. e.g. 'salary for physiotherapist' or 'play equipment' or 'refurbishment of family room, etc. We do not need a full description at this point.
- Request Summary
- Estimated Project Start Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Estimated Project End Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Project value £
  Please include VAT
- Total amount requested from Charity £
  Please include VAT
- Division:
- Other Divisions:
  If across multiple
- APPLICANT CONTACT DETAILS
  Please ensure that your details are correct so that we can contact you.
- Applicant name:
  
  First nameLast name
- Position/Job role:
- Speciality/area:
- Email address:
- Phone number:
- PROJECT LEAD CONTACT DETAILS
  Only applicable if different from grant applicant
- Project lead name:
  
  First nameLast name
- Position/Job role:
- Speciality/area:
- 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 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?
- 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.
  Cancelof
- 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.
  Cancelof
- Requests over £5,000 require additional sign-off from the divisional director. Is your request over £5,000?
- DIVISIONAL DIRECTOR APPROVAL
  Please provide authorisation from the divisional director. Failure to do so will mean we cannot proceed with the application.
  
  The divisional director can send an email to grants@bwhospitalscharity.org.uk stating the application and their approval. Alternatively, you can upload a screenshot or document of your divisional director's approval below.
- Divisional Director name
  
  First NameLast Name
- Email address:
- Has your divisional director sent a written email of authorisation to the Bristol & Weston Hospitals Charity grants team?
- Please upload your written evidence of support from the divisional director 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.
  Cancelof

- SECTION B
  
  PROJECT DETAILS
  This section is for you to tell us more about the project/item you would like funding for
- Charity Pillars
- Activity Description
  What do you want to do and why? If relevant, please include budgets and timescales.
- Other Project Details
  (e.g. Delivery address - must be BFT site)
- Ongoing Costs
  The Charity cannot pay for ongoing costs of projects. If there are any ongoing costs, please detail how these will be met
- If applicable, attach any evidence of approval (e.g. fire safety, infection control)
  
  This could be a jpeg, png, pdf, doc, xls, csv, zip. Emails need to be a screenshot and saved as one of these files.
  Cancelof
- For equipment or space enhancements, please provide evidence (where applicable) of approvals from IM&T, Core Clinical Services, Fire Safety, Infection Control and any other relevant Trust service.
  
  This could be a jpeg, png, pdf, doc, xls, csv, zip. Emails need to be a screenshot and saved as one of these files.
  Cancelof

- SECTION C
  
  INTENDED IMPACT OF THE PROJECT/FUNDING
  This section is for you to explain what the intended impact of the project/funding will be.
  
  This helps us explain to funders how their donation is used and the impact it will have on patients and staff.
- Intended Impact
  Outline the impact this project will have on patients and/or staff. How will this spend make a difference? How you will measure learning and/or success?
- Enhancing NHS Service
  Please outline how this request provides services over and above the level of services that the NHS should be providing
- How do you expect this project to impact clinical practice and outcomes?
- Estimated frequency that patients or staff will benefit:
- How many people will benefit from the project/funding?
  Please provide numbers of those benefiting from this project (preferably over the course of 12 months)
- Patients:
- Staff:
- What is the grant for?
- How do you expect this project to impact clinical practice and outcomes?
- Outline how research findings will be published:
- Estimated number of hours of training :

- SECTION D
  
  PROJECT COSTS & PAYMENT METHOD
  Please provide a breakdown of the costs associated with this application.
  
  You must attach evidence below to support these costs.
- TOTAL AMOUNT £
  Please ensure that ALL costs are included at the time of applying.
- VAT included?
- Upload your evidence to support the costs above. 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.
  Cancelof
- Payment method:
- Payee Name
- Account number
- Sort code
- Internal Cost Centre
- Subjective Code
- Bristol & Weston Hospitals Charity will only pay initial costs. All ongoing costs for maintenance must be agreed by ticking the boxes below.

- We'd love to keep you up to date with the latest charity news, impact, events and and appeals. Let us know if you'd like to sign up to receive email from our charity. We'll never share your data and you can unsubscribe at any time.
- Please note that any missing information, including authorisation and evidence of costs, will result in delays or may result in your application not being considered.
  
  If you wish to draft an application, there is a 'Save and Continue Later' option below, HOWEVER this will only allow you to save one draft at a time (everytime you save a draft, it will overwrite what you did previously). If you wish to make more than one application and save drafts, please contact us at grants@bwhospitalscharity.org.uk for a draft form before using this platform.
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