RURAL DEVELOPMENT FUND –
Application Form 2016/17
Deadline – 12 midday on Monday 11 April 2016
You can apply for a grant online or download a digital copy (PDF) of the application
form, and accompanying guidance notes, at www.rugby.gov.uk/grants
Please read the guidance notes before completing this form. Please use black ink or
typescript.
IMPORTANT - APPLICATIONS MUST SHOW HOW THE PROPOSED ACTIVITY WILL
HELP TO MEET THE KEY PRIORITIES FOR THE LOCALITY IN WHICH THE PROJECT
IS TO TAKE PLACE.
SECTION A – HEADLINE INFORMATION
1. Project title/activity
2. Name of group or
organisation applying
3. Number of people living in
the parish (where did you find
this information from).
4. Amount of funding requested
(maximum £10,000)
See guidance note re; match
funding requirements.
5. Purpose of group or
organisation
What are the main aims and
activities of your organisation?
6. Project aim
What is the main aim of your
proposed project?
7. Target community
Who will benefit from this
project?
8. Contact details:
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Your name:
Position within organisation:
Address:
Postcode:
Telephone:
E-mail:
9. Where will the project be
based?
If the project is delivered from a
base, which is different from
the organisation address or the
address of the main contact,
please provide the full address.
Does the venue have full disabled access? – Yes / No
SECTION B – PROJECT INFORMATION
10. Project need:
What is the need or problem
your project is trying to tackle?
How has this need been
identified?
Who has been involved in
developing the project?
What options have been
considered?
How have you sought the views
of potential beneficiaries?
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11. Project description:
What do you intend to do to
address the need identified
above?
What are your objectives?
What activities will you
undertake?
Who will be responsible for
delivering the project?
12. Contributing to the priorities
of the Rugby Regeneration
Strategy report - Achieving
Social Inclusion in Rugby
Borough’s Rural Areas.
Please identify if / how your
project will contribute to the
objectives of the rural social
inclusion report (see guidance
note).
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13. Relationship to other
projects, partnerships and
services.
How will your project fit in with
any related projects or
services?
What other organisations will
be involved in the project?
14. How will you know you have
achieved your project aim?
Please relate this to your
answer in Question 5.
15. What benefits will your
project achieve?
How many people do you
expect will benefit from your
project?
How many new volunteers do
you hope to recruit through the
project?
BENEFIT
TARGET
Number of beneficiaries
Number of new volunteers (if
applicable)
Others (please state):
Are there any other benefits /
added value that your project
will achieve?
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16. Project timetable
What is the planned timetable
for the project, including, the
expected start date, dates of
key activities (such as
purchase of key items, holding
an event, all funding secured),
and when the grant will be
spent by?
ACTIVITY
DATE
Project Start
Project End:
17. Budget
ITEM
COST
Please provide a simple
breakdown of how the grant will
be spent.
Please attach estimates or
other information where
possible to justify costs and
show value for money. For
purchases / works – copies of 2
quotes must be provided.
TOTAL:
18. Total cost of project
Total cost of project: £____________________
What is the total cost of the
project?
You will be awarded a
percentage of the total project
cost. The percentage of grant
that the council will contribute
towards any project is based on
the population of the parish to
which the project relates (see
guidance notes).The grant will
not be released without
evidence that there is match
funding in place to cover the
remaining costs.
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Other funds applied for/secured (including amount):
Funding Source
(e.g. Lottery, own
resources, etc)
Amount
(e.g. £5,000)
Status
(e.g. awaiting
decision,
confirmed)
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19. Possible risks to the success
of the project.
What factors might delay the
project or otherwise prevent
you delivering your aims and
objectives? (For example:
failure to secure match funding;
failure to recruit volunteers)
How will you minimise these
risks?
20. Sustainability of the project
What do you expect to happen
once you have spent your
grant?
How will your project provide
lasting benefit to your local
area or group?
How do you plan to obtain any
additional funding required to
sustain the project?
SECTION C – YOUR ORGANISATION
21. Status of your organisation
Please explain the status of
your organisation.
(For example: independent
voluntary organisation,
registered charity, company
limited by guarantee, affiliated
to national association).
22. How many people are
currently involved in your
organisation?
Management committee
Other volunteers
NB. This question will help us
to get an understanding of the
different types of organisations
that benefit from this fund.
Paid staff
Service-users
Other members
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23. Does your organisation
have?
A copy of your organisation’s
constitution and audited
balance sheet / profit and loss
and details of any financial
reserves and their intended use
must be submitted with your
completed application
IMPORTANT – If your grant
application is successful you
may be required to submit
copies of the additional
documents. If it transpires that
you are unable to produce
these documents we may
consider this to be an attempt
to secure funding by fraudulent
means and further appropriate
action will be taken.
All successful applicants will
need to have minimum
£5million Public Liability
Insurance in place or be able
to put it in place before
implementing the project. You
will be unable to draw down
your grant without submitting
proof of appropriate insurance
cover.
If you do not have a
constitution and audited
accounts, your grant will need
to be administered by an
established organisation, to
whom the grant will be paid on
your behalf.
24. Are there any important
items / events likely to affect
the current financial position
of your organisation?
Has your organisation got a
Constitution?
Yes
No
Has your organisation got
recently audited accounts
Yes
No
Does your organisation hold each of the
following documents?
Health and Safety Policy
Yes
No
Equalities Policy
Yes
No
Child Protection Policy
Yes
No
Appropriate insurances
Yes
No
Please specify the level of
insurance cover
(amounts and type)
Date insurance cover expires
Name & address of administering organisation (if
applicable):
YES / NO
Detail and impact:
If ‘yes’ please provide more
detail, including the likely
impact
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25. If your application is
successful, how will you
publicise the support given
by Rugby Borough Council
in helping you with your
project?
26. Additional information
Please use this section should
you wish to provide additional
information that may assist in
your application. Please use a
separate sheet if you need to.
27. Signature of main contact
person
As detailed in Question 7.
28. Date
29. How did you find out about
this grant fund?
Please return the completed application form and supporting documents to the Housing and
Community Development Team, Rugby Borough Council, Town Hall, Evreux Way, Rugby,
CV21 2RR or email grants@rugby.gov.uk by 12 midday on Monday 11 April 2016.
If you have any queries please contact the council on (01788) 533533 or e-mail:
grants@rugby.gov.uk
Data Protection Act – the information contained on this form will be held by the council and
will be subject to the provisions of the Data Protection Act. The Act requires the council to
safeguard this information and the use made of it.
The information given on this form may also be used for data matching exercises to assist in
the prevention and detection of fraud and corruption.
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