IDP Community Grants Application Form 2013 - Inishowen ...

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12 Νοε 2013 (πριν από 3 χρόνια και 9 μήνες)

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Application Form



Small
Grants for Community Groups 2013



Applications are welcome from community groups who are engaging in projects that promote
the goals of the Local Community Development Programme. Detailed information on the goals
of the LCDP is available on our website and can be sent to applicant groups
.

Completed applications should be returned to John Jackson at Inishowen Development
Partnership, St Mary’s Road, Buncrana, Inishowen, Co. Donegal TEL: 074
-
9362218
via email
(
john@inishowen.ie
) or hard copy to be
received not later than closing date.

CLOSING DATE FOR RECEIPT OF COMPLETED APPLICATIONS
-

4.00pm Friday,
May

31
th

201
3








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2


SECTION ONE

APPLICANT DETAILS

1. Name of Group or
Organisation:




2. Please identify the

Legal status of your

group or
organisation and
identify whether or not it
has charitable status:




Y=YES

Insert
relevant

Number

N=NO

Company Limited by Guarantee





Cooperative



Constitution, Memorandum and Articles



Charity (charitable status)



Other (please specify
)


3. Contact Details

Contact


Chairperson

Contact



Other

(Committee member, Director or
employee)



Name:



Position / Job Title:

Chairperson


Address
:



Telephone (landline):




Mobile Number:




E
-
mail address:



4. Please provide a brief
background history of your group or organisation i.e. how and why your group
was established, it’s mission, aims, objectives, it’s main activities and what you have achieved to date:





5. Date of establishment of group or organisation:



Month


Year

6. Date of Last AGM






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3

7. The Local Community Development Programme identifies 20 different categories of economically /
socially disadvantaged persons who are classified as being at risk of poverty and social exclusion within
Ireland. People can be considered as members of one
or more of these target groups based on their
personal circumstances. In this section, applicants are asked to
select
the target groups expected to
benefit from their project. Select up to a maximum of three target groups only, by selecting “Y =YES” in
the table below.

Applicants are then asked to estimate for those target groups selected, the number of children or
adul
ts (male, female, total) or the number of other groups organisation’s or networks expected to
benefit from the project.

Please select up to a
maximum of three

key target groups most relevant to your project

Asylum seekers /
refugees


Lone parents


Disadvantaged men


Low income Families


Disadvantaged women


Non
-
Irish Nationals


Disadvantaged Young
People


Offenders


Drug / Alcohol Mis
-
users


Older people (>55 years)


Early School Leavers


Parents/Carers of Young
People at Risk


Family Carers


People with Disabilities


Homeless People


Prisoners / Ex
-
prisoners


Individuals who are
unemployed


Travellers


Lesbian, Gay, Bi
-
sexual
and Transgender
people


Under
-
employed (Seasonal
workers)





8.
Please provide an estimate of the number of
beneficiaries of the proposed project:


Male

Female

Total

Number of children / young people (<18 years)




Number of adults (>18 years)





9.
Please indicate what geographical area your
project represents

( If your electoral division is
known please indicate which DED)





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4

PROJECT DETAILS



SECTION TWO

10.
Describe the proposed project for which a grant is now being sought.

What does it aim to achieve?
How will you deliver the project? What geographical area does your project cover? Who will benefit
from your project?
What are the expected outcomes of your project?








11.
Evidence of need. How did your group determine the need for this project? Which did you use
statistical data or local knowledge to develop your project. Please outline your reasons for the
project.






12.
How does this project fit with the aims and obj
ectives of the Community Development Programme
of the Inishowen Development Partnership?
i.e. tackle poverty and social exclusion with specific
reference to the beneficiaries / target groups?





13.
What is new and innovative about your project?




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5

14.
If this project is approved,what are the start and end dates of the project?


15.
Describe how your group / organisation will measure the achievements and impact of the
proposed project? (e.g. attendance sheets
, evaluation forms, feedback etc)




16.
Please provide a breakdown of the costs of your project?

Item

Cost

Requested for grant
aid
by IDP
. Please
tick as appropriate













Total






17.
Give details of additional sources of funding which are available for this project, for

example, cash
on hand, donations, fund
-
raising activities and so on.



18.

Please list all grant aid / funding which your group or organisation has received in the last three
years in the table provided below:

Funding Organisation

Purpose of Funding

Date Approved

Amount €





















Total €



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6


1
9. Is your group currently registered on
the County Development Board
database of community groups?

Y=YES


N=NO


If no, would you like to receive a registration form
?

Y=YES


N=NO



2
0.
Inishowen Development Partnership

may be in a position to offer your group/organisation non
-
financial support i.e. finance training, committee skills training, capacity building, lobbying, other (as
required). Please outline any additional supports require
d by your group.








2
1. Does your group have the necessary insurances in
place to deliver the project?

Y=YES


N=NO








2
2
. Bank Account Details



please proviTe Te瑡ils o映瑨e bank accoun琠which your group or organisa瑩on
will⁵se⁦ r⁡ l⁦inancial⁴ransac瑩onsn⁴his⁰牯jec琮


Name of Bank:



Address of Bank:








Sort Code:


Account Number:




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SECTION THREE

DECLARATION AND
DATA PROTECTION
DISCLOSURE

The following Declaration

and,

Data Protection Disclosure
must be signed and dated by two members
of your group or
organisation’s

executive
management committee
, one of whom
MUST

be the
Chairperson.


23. DECLARATION

We, the
undersigned, apply
to Inishowen Development Partnership
for a grant under the Local and
Community Development Programme

towards the proje
ct described in this application.

We dec l ar e
t hat al l t he i nf or mat i on gi ven i s t r ue and c ompl et e t o t he bes t of our kn
owl edge and bel i ef. We
ac knowl edge t hat any f unds awar ded mus t be us ed f or t he pur pos e s t at ed and not us ed t o r epl ac e
exi s t i ng f undi ng or f i nanc es. We al s o ac c ept, as a c ondi t i on f or t he al l oc at i on of f undi ng, t hat i t i nvol ves
no c ommi t ment t o any ot her g
r ant s f r om
I DP.

Fur t her mor e, t he pr opos ed pr oj ec t wi l l not i nvol ve
dupl i c at i on of exi s t i ng f undi ng, s er vi c es, ac t i vi t i es or r es our c es of t he gr oup.
We, t he under s i gned,
agr ee t o have t he pr oj ec t moni t or ed by t he r el evant aut hor i t i es and t o al l ow ac c es s t o
pr emi s es and
r ec or ds, as nec es s ar y f or t hat pur pos e.

24. DATA PROTECTI ON DI SCL OSURE

We, t he under s i gned, her eby c ons ent

i n ac c or danc e w
i t h t he Dat a Pr ot ec t i on Ac t s 1998 and 2003,

t hat
I ni s howen Devel opment Par t ner s hi p
, Pobal and t he Depar t ment of
Envi r onment,
Communi t y and
L oc al
Gover nment

wi l l be gi ven ac c es s t o al l ac t i vi t i es and r ec or ds r el at ed t o t he pr oj ec t and

s hal l be ent i t l ed
t o publ i s h, i n ac c or danc e wi t h t he f under s r equi r ement s on i nf or mat i on and publ i c i t y, det ai l s of t he
Gr ant Ai d and t
he pur pos es and r es ul t of s uc h expendi t ur e.

Name (BL OCK CAPI TAL S)


Name (BL OCK CAPI TAL S)


Si gnat ur e


Si gnat ur e


Pos i t i on i n gr oup /
or gani s at i on

C
hai r per s on

Pos i t i on i n gr oup /
or gani s at i on


Dat e:


Dat e:





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8







FOR OFFICE USE ONLY

Type of Group. eg
. Issue/area
-
based


Application Received Date


Details of other EU Funding if Applied


Details of Matching Funding


Checked with other Agencies


Tax Clearance Certificate if over €6,350


Date of approval by Sub
-
Committee


Date of Approval by Board


Amount Approved


Payments Instalments, Cheque & a/c No.


Date of Monitoring Visit


Comment




Group objectives




Expected outcomes




Linkages




Financial Report from Grantee


Final Report