Brent Fair Share Trust
(Office use only)
Date Received:
Page 1 of 12
Reference No:
FS-11-
BRENT FAIR SHARE APPLICATION FORM
Before completing this application form please read the Guidance Notes. Please type your answers or hand-write clearly, using black ink.
Name of Group:
Project to be funded:
SECTION 1 - About your group
1. Is your group part of a larger organisation?
No Yes, we are part of: _________________________________________________
2. Please give a description of what your group does.
If it is connected with any other organisation, please also explain the relationship.
(continue on separate sheet if necessary)
3. When did your group start? Month: Year:
4. In which geographical area(s) does your group work? Please list all the boroughs, wards and areas covered by the group’s different activities, not just for this project.

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5. How many people are actively involved in your group? (write number in each box)
Please count everyone involved in running the group over the past 12 months, and put each person under one category only. Do not include people who only give financial support.
Committee members / trustees
(unpaid)
How many live in Church
End and Roundwood?
Volunteers and unpaid workers
How many live in Church
End and Roundwood?
Paid workers (full-time)
Paid workers
(part-time and sessional)
How many live in Church
End and Roundwood?
How many live in Church
End and Roundwood?
Members, users and beneficiaries
How many live in Church
End and Roundwood?
SECTION 2 - About your summer holiday project
6. Please explain exactly how you plan to use the Fair Share Trust funding.
6.1. What are you planning to do? What activities will you provide?
6.2. At which location or venue? Please include address and postcode where possible.
6.3. When will activities take place, how often and how long for?
6.4. Who have you spoken to for help with the project and who will be involved?
Will you be working in partnership with anyone?

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6.5. Who is your project for (ages, gender of participants)? How many children & young people do you expect to benefit from your project, and how many of them live in Church End and
Roundwood?
(Please note: the area boundaries are the railway line in the west, then Neasden Lane – High
Road – Cobbold Road – Franklyn Road – Roundwood Road – Longstone Avenue – Drayton Road
– St Mary’s Road – Craven Park Road and Craven Park (south) back to the railway line.
See Guidance Notes for a map.)
6.6. How will you ensure that you reach the children and young people whom the project is meant to benefit? What contacts do you have with local parents and children? How and where will you publicise the project?
6.7. Are you planning to buy any equipment? If so, where is it going to be placed, and how will you ensure it is accessible and safe from damage or theft? What will happen to it after the summer holidays?
7. Planned project start date:
(This must be before you book any venues or spend any money e.g. on publicity)
8. Planned project completion date:
(Please note: Summer holiday period runs from Wednesday 23 July to Sunday 31 August)
9. Why do you want to run this project? What experience do you have of running similar projects?
10. How will your project improve life for children and/or young people in Church End and
Roundwood? What is the main positive result (outcome) you hope to bring about?

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11. How will know that this change has occurred? What evidence can you collect to show that your project has achieved its intended result and made a difference?
12. How will you measure what difference your project has made? What methods will you use to
collect the evidence? You will need to record beneficiary details and keep attendance records.
We will also expect you to monitor and evaluate your project outcomes. How are you planning to do this?
13. How much Fair Share funding are you requesting for your project? £
14. Will the proposed Fair Share funding cover the total cost of your project holidays? Yes.
No. (please tick as appropriate)
15. If not, how much do you expect the project to cost in total? £
16 Where will the rest of the money come from?
17. Have you got it already? If not, when will you know?
18. Has your group received funding for a project like this before? Yes. No.
If yes, please provide details here:
19. Please give a detailed breakdown of how much will be spent on the different parts of the project if your application is successful.
Please clearly separate Fair Share-funded items from any match funding.
All items in your budget should relate to, and be justified by, your project description above.

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COSTS TO BE FUNDED BY FAIR SHARE DURING THE SUMMER HOLIDAY PERIOD:
Cost item (e.g. room hire - Youth
Centre)
TOTAL
Cost detail (e.g. £25 x 3hrs x 26 wks) Total Cost in £
FAIR SHARE GRANT REQUESTED: £
OTHER FUNDING CONFIRMED OR EXPECTED FOR THE SAME PERIOD:
Funder / source What will it pay for? Amount in £
TOTAL
TOTAL
+ APPROXIMATE VALUE OF
SECURED MATCH FUNDING: £
UNCONFIRMED MATCH FUNDING: £
MATCH FUNDING IN KIND: £
TOTAL COST OF PROJECT: £

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SECTION 3 - More information about your group
20. Where is your group based? (street / postcode)
This will be where your office is (if you have one), or where your group usually meets.
21. Does your group have a set of agreed rules or a constitution? Please tick as appropriate.
Yes: please enclose a signed copy with your application
No: please enclose a statement of your group’s aims, signed by all current members
22. What is the legal structure of your group? Please tick all that apply.
Unincorporated organisation
Company limited by guarantee, registration number ................................................................
Company limited by shares, registration number ......................................................................
Registered Charity, registration number ....................................................................................
Industrial & Provident Society, registration number ..................................................................
Community Interest Company, registration number ..................................................................
Other: ..........................................................................................................................................
23. What policies and procedures do you have in place?
Criminal Records Bureau (CRB) checks for staff & volunteers
Child Protection Policy, please enclose a signed copy with your application
Vulnerable Adults Policy, please enclose a signed copy with your application
Health and Safety
Risk Assessment for Project Activities
Equal Opportunities Policy, please enclose a signed copy with your application
Other: ..........................................................................................................................................
24. What insurance cover do you have in place?
Public Liability up to £ ....................................................... Expiry date: ......................................
Employers’ Liability up to £ ............................................... Expiry date: ......................................
Theft up to £ ...................................................................... Expiry date: ......................................
Accidental Damage up to £ ............................................... Expiry date: ......................................
Other: ..........................................................................................................................................
25. When is your next Annual General Meeting due? ______________________________________
26. How much income did you receive in the last financial year? £
27. Has your group produced annual accounts?
28. Is your group registered for VAT?
Yes
Yes
No
No

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29. If yes, what proportion of VAT can you reclaim? _______________________________________
30. Has your group got its own bank or building society account?
31. Can you hold restricted funds in this account?
32. If you have not got your own bank account, who could hold the funds for you?
Yes
Yes
No
No
SECTION 4 – Declaration
It is essential that you understand and agree to sign up to the following statements. Please note that if you leave the organisation or can no longer fulfil your responsibilities, or someone else takes over responsibility for the grant on behalf of the organisation, you must inform us immediately.
Our signatures confirm our acceptance of the conditions below:
We agree to abide by the terms and conditions of the grant as they are set out in the application form and the accompanying guidance.
We certify that the information contained in this application is correct and that we are authorised by the organisation to accept these conditions on their behalf.
If successful we will not use the grant for any other purposes, other than those specified, without first receiving authorisation from the North West London Community Foundation.
We agree to participate in monitoring, auditing and evaluation relating to this fund as detailed in the guidance.
We will keep the receipts for any payments made with this grant and will send copies of the receipts along with an End of Grant Report to the North West London Community Foundation at the end of the project.
We will account for the grant separately in our organisation’s annual accounts. We will send a signed copy of these to the Community Foundation once they are ready.
We understand that further information about the organisation and/or the proposed project may be sought before a final funding decision will be made.
We understand that new grants will not be awarded to any groups funded before unless all monitoring information is up to date (if project is on-going) or unless and until all previous funding is fully accounted for (if project is complete).
We are aware that Fair Share Trust is a Lottery-funded programme.
Name: (named main contact in Section 5)
Signature:
Name: (2 nd senior member of the group)
Signature:
Position in Organisation: Two different signatures are required.

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SECTION 5 – Contact details (please complete all four parts!)
1. Main Contact for this application:
Preferred title: Full name:
Position in Group:
Contact Address:
Postcode:
Other contact details:
Tel. no.: (day)Tel. no.: (evening)
Mobile: __ Fax:
E-mail:
What is the best time to contact you?
If you have any particular communication needs, what are they?
2. Chairperson of the Group: (if n/a please give Company Secretary details)
Preferred title: Full name:
Home Address:
Postcode:
Other contact details:
If this person has any particular communication needs, what are they?
3. Treasurer of the Group:
Preferred title: Full name:
(if n/a who oversees the group’s finances?)
(Home) Address:
Other contact details:
Postcode:
If this person has any particular communication needs, what are they?
4. What is the official correspondence address of your organisation?
1 2 3 Other:
May we pass on your official correspondence address to other organisations? Yes.
No. (Please tick as appropriate.)

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SECTION 6 –Independent Referee
You must provide us with details of an independent referee.
Your referee must be a person with a professional or public position whose status we can check.
They must be completely independent of your organisation but know its work well and know about the project for which you are requesting funds. Please do not give the details of a relative,friend, partner another member of the group, or anyone who would benefit from a grant being awarded to your project.
All information provided will be kept in accordance with our data protection policies.
Title: Full name:
Profession/Job title:
Organisation name/Employer:
Home address:
Postcode
Daytime Telephone Number
Mobile Telephone Number
Email address
How long have you known the organisation? Years Months
Please describe the nature of your relationship with the applicant.
I know this organisation and I have read and support this request for funding. I am willing to be contacted to discuss this application and also comment on any grant awarded.
Signed
Date

Brent Fair Share Trust
Checklist – before you send in your application:
Page 10 of 12
Please go through this list when you are ready to post your application, and enclose all the documents it mentions.
Have you answered every question and completed all five sections?
Is your application form signed by at least two members of your group?
Have you made a copy for your own records?
Have you enclosed your constitution, or a signed statement of your group’s aims and objectives? Or do we already have a copy?
Have you enclosed a full list of names of the members of your management committee
(trustees) and all employees / paid workers?
Have you enclosed your group’s latest annual accounts, or a statement of income and expenditure for the last year if the group has been funded but not yet produced formal accounts?
Or do we already have a copy of your most recent accounts?
Have you enclosed your organisation’s child protection policy?
Or do we already have a copy?
Have you enclosed your organisation’s equal opportunities policy?
Or do we already have a copy?
Have you enclosed any continuation sheets, or additional information you would like us to have?
Have you double-checked that you are using the correct amount of postage?
Please send your completed application form, list of trustees and staff, constitution, accounts and policies by post to the address below. kath.s@nwlondoncf.org.uk
Kath Sullivan
Grants Development Manager
North West London Community Foundation
Central Depot ( Unit 4)
Forward Drive
Harrow
MIDDLESEX
HA3 8NT
Tel: 020 8909 2788
Fax: 020 8909 2730