Application Form

Please read all advice in the Guidance Notes Section notes as you complete this form and ensure that you have explored and considered all sections of our website.

"*" indicates required fields

Section A - Your Charity Profile

Section A1

Organisation Name*

In which Yorkshire region is your project based?*

North

East

South

West

Charity Commission registration number*

Date of registration*

DD slash MM slash YYYY

Your website address

Email address*

Your postal address (NB This MUST be in Yorkshire)*

Street Address City ZIP / Postal Code

Where did you hear about us?*

Chair of Trustees*

Chair of Trustees contact email*

Chair of Trustees contact number*

Name of person submitting application*

Position in organisation*

Contact email*

Contact number*

Section A2

Please state the objects of your organisation as registered with The Charity Commission with any change of focus or update which may not yet be included on The Charity Commission website. Please give your main areas of interest.*

Section A3

Please provide figures from the last 3 years' accounts, starting with the most recent.

Year ending*

DD slash MM slash YYYY

Income*

Expenditure*

Year ending*

DD slash MM slash YYYY

Income*

Expenditure*

Year ending*

DD slash MM slash YYYY

Income*

Expenditure*

How is your organisation funded, based on your latest accounts?*

Do you have a 'Reserves' policy? **

Yes

If yes, what is it? (Max 50 words)*

What was the value of unrestricted reserves at the end of the reported accounting period?*

What is your current level of unrestricted reserves as a % of your annual expenditure?*

Section A4

Has your charity previously submitted a grant application to The Brelms Trust?*

Yes

What date did you last previously apply?*

DD slash MM slash YYYY

Was the application successful?*

Yes

If yes, what was the total value of the grant?*

Year 1 amount*

Year 2 amount

Year 3 amount

Is this a re-application for the same purposes?*

Yes

Section B - Your Funding Request

Section B1

Describe in general terms what the funding is for (max 75 words)*

Is this funding application to enable you to:*

provide a new service or activity

continue with your current service or activities

Section B2

We can award either one-off or multi-year grants (ie. spread over three years). Please tick the relevant box below to inform us which option you require.

If you require a one-off grant, please enter the full amount required.

If you require a multi-year grant, please enter the amount required each year.

Is this application for a one-off grant or a multi-year grant?*

One-off

Multi-year

What is the total amount requested? (Maximum £18,000)*

Please enter a number from 1 to 18000.

What is the total amount requested? (Maximum £6,000)*

Please enter a number from 1 to 6000.

How much do you require in Year 1? (Maximum £6,000)

Please enter a number from 1 to 6000.

How much do you require in Year 2? (Maximum £6,000)

Please enter a number from 1 to 6000.

How much do you require in Year 3? (Maximum £6,000)

Please enter a number from 1 to 6000.

What date is your first funding required?*

DD slash MM slash YYYY

NB This may pre-date your project's actual start date

Provide details of how the grant will be spent (max 75 words)*

How will this funding make a difference? (max 75 words)*

Who will benefit?*

How many?*

Which specific geographical area?*

Brief socio-economic profile of the area (max 50 words)*

How are potential beneficiaries referred to you?*

What is your strategy to try to ensure the sustainability of the activities covered by your application? (max 75 words)*

How will you measure the success/value of the work covered by this application? (max 100 words)*

Section B3

Who is ultimately responsible for the work of the project?*

Who will deliver the on-going work/project?*

Position in organisation*

Name of second person

Optional

Position in organisation

Section B4

Have you applied for any other funding which is related to this application?*

Yes

How many other applications have you made?*

Application 1*

Application 2*

Application 3*

Application 4*

Application 5*

Application 6*

Please list any other PLANNED applications for funding which are related to this project/activity, or indicate if none.

Section B5

Please only use this space if you would like to clarify any issues relating to reserves, designated funds or if you feel that there are aspects of your project which have not yet been fully described.

Section B6

If your application is successful payment will be made to your organisation by bank transfer. Please provide bank details. Please take care to give these bank details accurately.

Name of bank*

Name of account*

Sort code*

Account number*

Section C - Monitoring & Evaluation

Section C1

Trustees see this process as key to measuring the effectiveness of their grant giving and it is not just a bureaucratic exercise. It is important to be honest about the project’s successes and failures. It is crucial that an accurate assessment of the impact of our grant is made. We reflect on this in our Annual Report and try to adjust our policies and practices based on this experience.

In submitting an application to us you are agreeing to provide timely information in the prescribed format (please see form on EXISTING GRANTEES' page) to enable us to carry out our own monitoring and evaluation activities.

Who will be responsible for submitting the Monitoring and Evaluation Report(s) at the year-end to The Brelms Trust?*

Email address*

Contact number*

Section C2

The Trustees may wish to visit your organisation either prior to a final funding decision being made or prior to releasing funds for a second or subsequent year. Please provide contact details of the appropriate person if this needs to be arranged.

Name*

Email address*

Contact number*

Please Note

As part of the Monitoring and Evaluation process, Trustees may use your answer to the first question from the M & E Report (ie ‘Describe how your project has benefitted from our grant’) as a testimonial verbatim. This may then be included on our website to highlight the diversity of the projects we fund.

Section D

Section D1

It is essential that you complete this section to notify us of any changes that you are already aware of which will occur during the lifetime of your award, if successful.

NB The separate Change of Details Form is for any changes which occur subsequent to the submission of your application. Please use that form each time a change of details occurs eg bank details, names of contacts, tel no etc. The form can be found on the Existing Grantees' Area of the website.

Please provide details of any known future changes

Section D2

Please confirm the following:

Your charity/project is solely for the public benefit of communities in Yorkshire*

Yes

The purposes of your charity meet at least one of the objects of The Brelms Trust*

Yes

Please refer to the Objects of The Brelms Trust section

You have read the eligibility criteria throughout the website, including the Home, What Do We Fund, We Do Not Fund and How to Apply for a Grant pages*

Yes

You have agreed to update this application with any new information that becomes available after your initial application is submitted but before being advised by the Trustees of their decision*

Yes

You have agreed to keep the Trustees informed of any significant changes during the duration of any grant that may be awarded*

Yes

You have attached the most recent set of accounts via an email to admin@brelmstrust.org.uk, if applicable (see section A3)*

Yes

Please attach a copy of your budget*

Max. file size: 128 MB.

Section E

Section E1

Did you find any part of our application form confusing or difficult to answer?

Name

This field is for validation purposes and should be left unchanged.