COMMUNITY FACILITIES PROGRAMME EXPRESSION OF INTEREST (March 2014) Please read the Community Facilities Programme Guidance before completing this form. Please return your completed expression of interest by e-mail to: CommunityFacilitiesproghelp@wales.gsi.gov.uk Or in hard copy to: Community Facilities Programme Communities Division Welsh Government Rhydycar Merthyr Tydfil Page 1 of 8 ABOUT YOUR ORGANISATION In order to apply for the Community Facilities Programme, the lead organisation must be a community and voluntary (third) sector organisation. This includes social enterprises. Name of organisation: Type of organisation (e.g. company limited by guarantee, CIC, Charity, etc.): Company and/or charity registration number if appropriate: Name of project: Address of project (including postcode): Address for correspondence (if different): Contact name(s) within your organisation: Page 2 of 8 Telephone number(s): E-mail address(es): Page 3 of 8 ABOUT YOUR PROJECT Tell us about your project. How would you use a Community Facilities Programme grant? What changes do you intend to make to your community facility? How have the users of your facility helped to develop the project? Please use no more than 500 words. What is the estimated total cost of your project and how have you worked this out? How much Community Facilities Programme funding are you seeking? Are you applying for match funding for the project? Yes / No If Yes, where from and is it approved? If No, where do you intend to apply for match funding and when? Page 4 of 8 How will you make sure your organisation can deliver your Project? What experience does your organisation have of delivering similar projects? What relevant skills and experience do your staff or management committee/board have? Please use no more than 500 words. Page 5 of 8 ABOUT YOUR PARTNERS The Welsh Government is seeking to fund improvements to community facilities which are used by and useful to the communities they serve. We want applications from organisations working in partnership with others. Partners can be from the private, public or third sectors. We believe that telling us about the organisations you are working with will allow your application to demonstrate that the project is both of strategic value and sustainable in the medium term. Please tell us about your partners. WHO IS/ARE YOUR STRATEGIC OR KEY PARTNER(S)? (e.g. local authority, housing association, Welsh Government tackling poverty programme or similar). We may use this information to contact your partners about the project. Please provide names, telephone numbers and e-mail addresses for your contacts within the key partner organisation(s): ORGANISATION CONTACT NAME TEL NUMBER E-MAIL ORGANISATION CONTACT NAME TEL NUMBER E-MAIL ORGANISATION CONTACT NAME TEL NUMBER E-MAIL Page 6 of 8 Other than those partners mentioned above, are you working with other groups of organisations? If so, please tell us about these. Page 7 of 8 HOW IS YOUR PROJECT HELPING TO TACKLE POVERTY IN YOUR COMMUNITY? The main focus of the Community Facilities Programme is to prevent or tackle poverty. This is your opportunity to tell us how your community facility is, or intends to be delivering community services, that help the individual members of your community. The three tackling poverty strands are: helping people to have better economic outcomes; better learning outcomes; and better health and wellbeing. You’ve told us about your partnerships; now tell us about the activities that your facility is or will be hosting and how they will deliver outcomes under one or more of these three strands to individuals in your community. Please use no more than 500 words. Please tell us what is unique about your community facility. What do you offer that other facilities in your area do not? Tell us why your facility is needed by the community. Please use no more than 500 words. Page 8 of 8