Small Grant Application Form Save my progress and resume later | Resume a previously saved form Resume Later In order to be able to resume this form later, please enter your email and choose a password. Your Email: A Password: Confirm Password: Guidance Notes This application form is for grants up to £5,000. Please note, fields ending in * require an answer. Where a character length is specified, this includes spaces. Organisation Organisation Name Charity Number Organisation Address Line 1 Organisation Address Line 2 Organisation Address Line 3 Organisation Address CountyPlease select... Avon Bedfordshire Berkshire Borders Buckinghamshire Cambridgeshire Central Cheshire Cleveland Clwyd Cornwall County Antrim County Armagh County Down County Fermanagh County Londonderry County Tyrone Cumbria Derbyshire Devon Dorset Dumfries and Galloway Durham Dyfed East Sussex Essex Fife Gloucestershire Grampian Greater Manchester Gwent Gwynedd County Hampshire Herefordshire Hertfordshire Highlands and Islands Humberside Isle of Wight Kent Lancashire Leicestershire Lincolnshire Lothian Merseyside Mid Glamorgan Norfolk Northamptonshire Northumberland North Yorkshire Nottinghamshire Oxfordshire Powys Rutland Shropshire Somerset South Glamorgan South Yorkshire Staffordshire Strathclyde Suffolk Surrey Tayside Tyne and Wear Warwickshire West Glamorgan West Midlands West Sussex West Yorkshire Wiltshire Worcestershire Organisation Postcode Organisation Telephone Number Organisation Email Address Organisation Website Contact Details TitlePlease select... Mr Mrs Miss Ms Dr Professor Reverend Sir Dame First Name Surname Job Title Telephone Number Email Address Skype Name Organisation Details Charitable Purpose of Organisation Geographical Remit of OrganisationPlease select... UK International (not including UK) Worldwide Geographical Remit of Organisation (if UK)Please select... Aberdeenshire All Anglesey Angus (Forfarshire) Antrim Argyllshire Armagh Ayrshire Banffshire Bedfordshire Berkshire Berwickshire Breconshire Brighton and Hove Buckinghamshire Buteshire Caernarvonshire Caithness Cambridgeshire Cardiganshire Carmarthenshire Cheshire Clackmannanshire Cornwall Cumbria Denbighshire Derbyshire Derry / Londonderry Devon Dorset Down Dumfries-shire Dunbartonshire Durham E. Riding of Yorkshire East Lothian East Sussex Essex Fermanagh Fife Flintshire Glamorgan Gloucestershire Greater London Greater Manchester Hampshire Herefordshire Hertfordshire Inverness-shire Kent Kincardineshire Kinross-shire Kirkcudbrightshire Lanarkshire Lancashire Leicestershire Lincolnshire Merionethshire Merseyside Midlothian Monmouthshire Montgomeryshire Morayshire Nairnshire Norfolk North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Islands Oxfordshire Peebles-shire Pembrokeshire Perthshire Radnorshire Renfrewshire Ross & Cromarty Roxburghshire Rutland S. Yorkshire Selkirkshire Shetland Islands Shropshire Somerset Staffordshire Stirlingshire Suffolk Surrey Sutherland Tyne & Wear Tyrone W. Yorkshire Warwickshire West Lothian West Midlands West Sussex Wigtownshire Wiltshire Worcestershire Geographical Remit of Organisation (if International)Please select... (All) Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Central African Republic (CAR) Chad Chile China Colombia Comoros Democratic Republic of the Congo Republic of the Congo Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates (UAE) United Kingdom (UK) United States of America (USA) Uruguay Uzbekistan Vanuatu Vatican City (Holy See) Venezuela Vietnam Yemen Zambia Zimbabwe Number of staff employed Number of volunteers Bank Details Bank Account Name Bank Account Number Sort Code Please provide the sort code without hyphens, ie '000000' Bank Name Bank Address In order to verify these bank details, EKCT requires a copy of a recent bank statement (no more than 3 months old). Please upload this here: This bank statement must be for the same account as detailed above, or any potential payment cannot be processed. Project Details What is funding sought for - project title Brief description of project Geographical remit of project Start date of project (if applicable) End date of project (if applicable) Who will benefit from the project and how many people do you estimate this to be for the duration of the project? Amount sought from EKCT Budget When is funding required by? What will happen if the total funds are not raised? How will you ensure the project is cost effective? Please attach a budget here (PDF): Budget should show: - captial project costs (if applicable), - operational project costs (if applicable), - other secured funders (name and amount), - other requested funders (name and amount), - what EKCT is being asked to fund and over what period, - any shortfall and how this is proposed to be met. If the request is for a salary, please attach a job description here: Key Staff Delivering Project 1. Name 1. Job Title 1. Project Role 2. Name 2. Job Title 2. Project Role 3. Name 3. Job Title 3. Project Role Financial Information What is the date of your last audited accounts? Please attach your most recent set of audited accounts here (PDF): For last financial year: Please answer the following questions as numbers only. Total Incoming Resources Cost of Generating Funds Expenditure on Charitable Activities Governance Costs These costs are associated with governance arrangements of the charity. These would relate to the general running of the charity as opposed to those costs associated with fundraising or charitable activity. The costs would normally include internal and external audit, legal advice for trustees and costs associated with constitutional and statutory requirements e.g. cost of trustee meetings and preparing statutory accounts. Also included in this category are costs associated with the strategic as opposed to day to day management of the charities activities. Support Costs These costs are those costs that, whilst necessary to deliver an activity, do not themselves produce or constitute the output of the charitable activity. Support costs will also be incurred in support of income generation such as fundraising and in support of the governance of the charity. These costs would normally included the central or regional office functions such as general management, payroll administration, budgeting and accounting, information technology, human resources and financial. Voluntary Income Cost of Generating Voluntary Income Total Reserves Total Unrestricted Free Reserves (Unrestricted funds excluding designated funds, tangible fixed assets & programme related investments) Please state your reserves policy and whether your current level of unrestricted free reserves is within this policy Other Information Please confirm that the Organisation has a Child Protection Policy (where appropriate), that policy is complied with and that Criminal Record Bureau checks are carried out on all staff working with children.Please select... Yes No Please provide any other information that you consider important for us to know: Save my progress and resume later | Resume a previously saved form Need assistance with this form?