SAME16. Project name/Summary (please give a short high-level description of the project that you are requesting funding for) * (max 100 characters):

 

SAME17. Local authority the activity will take place in:*
Please select all that apply
Hammersmith and FulhamKensington and Chelsea

18. Where will the proposed activities take place? *
Please include full venue information, including addresses and postcodes:

19. Start date of proposed activities *

20. End date of proposed activities *

SAME21. Please tell us about your project - what do you want to deliver? * (max 2500 characters)
Remember to include:
- Whether this a new or existing project
- Details of activities planned
- Who the beneficiaries will be and how many you expect to live, work or study in the Earls Court Opportunity Area
- How you know there is a need for your project, and how you have involved service users in its design
- What you aim to achieve with your project (the difference you aim to make and the changes you hope to see as a result of your activities) and how you will measure impact of your project
- If you expect to collaborate with other organisations and services on your project (please include names of organisations/services you refer to).
2500

 
SAME22. Which priority area(s) does your project focus on? *
(Please refer to application guidelines for full details)
Please select all that apply:
Communities & PeopleHealth & WellbeingYoung People & Training

SAME23.Have you received a grant from the Earls Court Community Fund before? *

Yes
No
 

SAME24. If yes, in which year(s)?

 

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25. Impact: Please tell us what you aim to achieve with your project - the difference you aim to make and the changes you hope to see as a result of your activities * (max 2500 characters)
2500

SAME26. Outcomes - Please select up to 3 outcomes for your project: *
Please select at most 3 options

27. How will you measure whether you have achieved these outcomes? * (max 1500 characters)
For example, you could use questionnaires, case studies, before and after measurements, photographs, observations, feedback etc.
1500

28. What difference will this funding make to your organisation? * (max 1500 characters)
1500

29. If you received partial funding towards your grant request, how would this affect your delivery plans and/or outcomes? * (max 1500 characters)
Whilst we aim to fund awarded projects in full, with limited budget available there is the chance only partial funding towards your project/request could be awarded
1500

SAME30. Anything else you would like us to know (max 500 characters)
500
 

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31. How many people will benefit from this funding? *
Please enter the number of people who will directly benefit from the project/activities i.e. the participants. If you cannot give exact figures please estimate as accurately as possible. This information is important and will be used to evaluate the project at the end of the grant period.

32. Of these, how many live, work or study in the Earls Court Opportunity Area? *

33. How many volunteers will be involved with the project? *
If you cannot give exact figures please estimate as accurately as possible.

34. Which groups will benefit from your project? * (please select all that apply):

35. If you have ticked more than one group in the list above, who would you say the main beneficiary group is? *

36. Which age groups will benefit from your project? * (please select all that apply):

37. If you have ticked more than one group in the list above, who would you say is the main age group that will benefit? *

38. Which ethnic groups will benefit from your project? * (please select all that apply):

39. If you have ticked more than one group in the list above, who would you say is the main ethnic group that will benefit? *

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SAME40. How much are you applying to the Earl's Court Community Fund for? *

SAME41. What is the total cost of the project? *

 

42. How much has been raised so far? *

 

43. Please give details of the funding raised so far *
Please specify the amount and source of funding secured to date

44. Please provide details of any other funding you are seeking *

45. Will participants be asked to contribute financially? *

Yes
No

46. If yes, please give details.

47. Please provide a budget breakdown. *
Please provide a breakdown of the project budget for which you are seeking funding in the following format:

Operational/activity costs

Staff costs

Volunteer costs

Capital Costs (equipment)

Office, overhead, premises costs

Publicity costs

Other Costs

DECLARATION
 

To enable us to consider your application, please confirm the following:
 

SAME48. My organisation: *
Is a not-for-profit organisation that is formally constituted
Has at least three unrelated trustees or directors
Has a bank account in its own name, with at least two unrelated cheque signatories
Has in place (where required), and can provide if requested, the following: Health & Safety policy, Safeguarding, Adults and Children policies, Equality & Diversity policy, Employers’ Liability Insurance, Professional Indemnity insurance and Risk Assessment log
 

SAME49. I confirm that: *

I am authorised to make this application on behalf of the above organisation, and I certify that the information contained in this application is correct to the best of my knowledge
I understand that if a grant is awarded, it can only be used exclusively for the purposes described
I understand that any personal information provided will be processed in accordance with the General Data Protection Regulation 2016
I understand that all details will be held and used in line with our privacy policy, and will be shared with third party partners for the purposes of administration
I understand that information about any grant awarded may be shared online, through social media and in published reports

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