City of Edinburgh Small Steps Big Difference Campaign Application for Funding Funding is available on a small grant basis to develop and/or deliver activities / resources for women aged 20 -49 years which meet the outcomes of the Small Steps Big Difference Campaign (see attached Guidance notes for criteria). You are invited to apply for up to £4000 in partnership with another organisation Grant funding 2012 Name of Project/Programme: Name of Organisation requesting funding: Name and Position of Contact Officer: Address Postcode: Tel No: Fax: Email: Please give a very brief description of your organisation’s main aims and activities: (150 words maximum) YOUR PROGRAMME/PROJECT Start date and end date of programme activities: Amount requested: Aims (Please indicate how this grant will be used to meet the outcomes of the Small Steps Big Difference Campaign Evidence of Need (please describe how you have identified the need for this resource or initiative) Sustainability – If appropriate, how you expect the benefits of approach to be sustained after the funding ends Who are you working in partnership with to deliver this project? Please provide a brief description of the organisation’s main aims and objectives. (150 words maximum) Have you obtained any consents, permissions or insurance necessary to carry out your proposal? Please tick relevant option (We may ask you for evidence of this) Yes No Not necessary Budget - How much will the programme/project cost in total; and where will any additional funding (over and above that requested from the Small Steps Campaign) come from? Expenditure Item e.g. staff time, other resources required. Estimated cost Income Sources of funding Amount £ Activities, Outputs, Outcomes Please complete this template (using the guidance re outcomes within briefing) Objective and Activity/Action Timescale Resources Outputs Target required (including target Group(s) or numbers of Area(s) service users) What bank account will you pay your grant into if your application is successful? Outcomes (what changes do you expect to see, and how many beneficiaries will experience this?) How you will measure the impact of your work (be clear about how you intend to evaluate your work) Name of bank Bank address Account name Bank sort code Account number If you are applying on behalf of a voluntary organisation, please make sure Please tick if that the following documents have been included with this application: attached Constitution or Memorandum and Articles of Association, Trust Deeds of your particular organisation Most recent annual (audited) accounts. Where your organisation is newly constituted, a most recent bank statement will suffice. DECLARATION All applications must be signed by two people who are recognised as representatives of your partnership. For voluntary organisations, one of these people must be a board/management committee member. You are being asked to declare that; To the best of your knowledge, that the information contained in this application and any accompanying attachments is accurate. Date…………………………………………… Signature……………………………………… Position………………………………………… Name…………………………………………… Signature……………………………………… Date…………………………………………… Name………………………………………….. Position………………………………………… FOR INFORMATION: EXPLANATION OF TERMS USED Appendix 1 Aim: what the project is trying to achieve overall Activity: what you will do Timescale: when it will be done by Resources: funding, staff time, other resources required. If staff time is the main resource please indicate the approximate proportion of the person’s time to be devoted to this activity. Output: to include, for example, how many times the activity will run and number of participants in the activity Outcome: the expected change or impact (usually on the participants) as a result of the activity e.g. improved confidence, knowledge Evaluation measure: how you will measure the anticipated outcomes e.g. post course evaluation forms etc