For office use only
Application Ref No.
Organisation Ref No:
Date of receipt:
Amount Requested £:
FOOD BANK SUPPORT FUND
APPLICATION FORM
1. To determine the eligibility of your project, please read the accompanying guidance
before completing your application form.
2. You must complete all of the questions on the form and in BLOCK CAPITALS.
Incomplete forms will be returned and only re-submitted into the Panel process once
complete. This may result in your application having to be considered within the next
bidding round.
3. Please address any enquiries about the completion of this form to the
Communities & Partnerships Team on 01924 305891 or via email to
foodbankfund@wakefield.gov.uk
4. When completed, please send this form and all supporting documents to:
Helen Purvis, Food Bank Support Fund, Wakefield Council, Wakefield One, PO Box
700, Burton Street, Wakefield, WF1 2EB
SECTION A – ABOUT YOUR ORGANISATION
A1
What is the name of your organisation?
A2
Please provide the address of your organisation:
Address
Postcode
Website
A3
What is the purpose of your organisation?
A4
Please give the name of the person dealing with this application, and their
position within the organisation eg Secretary or Treasurer:
Name
Tel Number
Mobile Number
Email Address
This must be the person who we can discuss the project with if we have any queries
A5
What is the legal status of your organisation?
e.g. Community Group, Registered Charity, Religious or National Organisation etc.
Please submit a recent signed copy of your constitution or aims and objectives that govern
your organisation.
A6
Do you have permission to deliver the project from the stated premises?
If you are not the landowner, we will require proof of security of tenure (lease agreement) and
written permission from your landlord before any funding can be released.
Updated August 2014
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SECTION B – ABOUT YOUR PROJECT / SCHEME
B1
What is the title of your project or scheme? (in no more than five words)
B2
What are you proposing to do with the grant? Please describe your project
/ activity.
B3
What is the timescale for your project?
Start Date:
B4
End Date:
Where will the project take place? (if this is different to the organisation
address eg a park or a community centre)
Location / address:
B3 What are the opening hours of the Food Bank?
Monday:
Friday:
Tuesday:
Saturday:
Wednesday:
Sunday:
Thursday:
Updated August 2014
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B4 How many Food Parcels do you currently distribute each week? (if any)
B5 Are you a member of Fare Share or a Food Trust? If so which one?
B6 What are / what will be the eligibility requirements of the Food Bank?
B7 Do you have any partnership arrangements in place??
E.g. with supermarkets, local suppliers, other food banks
B8
Grant requested from the Food Bank Support Fund :
Breakdown of items and cost you are
applying for
Cost of item £
(including VAT)
£
Quote/ Estimate
Included?
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
£
Yes
No
Total cost of the items you are applying for
£
from the Food Bank Support Fund
Estimates / quotes must be provided with the application. We cannot process your
application without this information. Photocopied catalogue pages are acceptable;
please note we are unable to accept written lists of items you are applying for.
Updated August 2014
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B9
Have you or do you intend to apply for funding from other funding
organisations, for the same costs/project?
Yes
No
If yes, please give further details.
What do you intend to do if you are awarded funding for the same costs/project
from multiple funding sources?
It is important that you make us aware if you receive any other funding for the same
project. Failure to disclose this information may result in you having to return the
funding. Please note we cannot accept receipts that have already been used for the
same project paid for by other funders.
B10
If your project costs more than the funding you are seeking from the Food
Banks Support Fund, where is this money likely to come from?
Amount (£s)
Please indicate if this
funding has been
secured.
Overall cost of project if larger
than total grant requested
£
Yes
No
Please list the funding sources
and their contributions to the
project
£
Yes
No
B11
Please outline below what plans you have in place to deliver this project
once the Food Bank Support Fund has been used?
Updated August 2014
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B12
Please name any Wakefield Council officers or Elected Members who are
assisting with this project.
B13
Please indicate if you would be interested in any of the following:
Advocacy Training for volunteers
Yes
No
Cook & Eat Sessions for customers
Yes
No
Food Hygiene / Health & Safety Training
Yes
No
Attend a workshop to share ideas with other Food Banks
Yes
No
If you are interested someone from the Council will contact you to discuss this further.
SECTION C – WHO WILL BENEFIT?
We require this information to ensure that the Food Bank Support Fund will benefit all
sections of the community in an open and accessible manner.
C1
Project Impact
a
Approximately how many people will access / benefit from your project?
b
Will specific groups of the community be targeted?
c
Can anybody take part in your project, regardless of race, gender, religion
or disability?
Yes
No
If no, please specify why:
d
How will you know that the activity / project has contributed to the
sustainability of your facility / provision and that you have achieved what
you set out to do?
Updated August 2014
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SECTION D – LEGAL DOCUMENTS
D1
Safeguarding Children, Young People and Vulnerable Adults
a.
Does your project involve work and / or contact with children, young
people under the age of 18 or vulnerable adults?
Yes
No
If yes, as a minimum we expect you to:







b.
Have a senior manager who is committed to children and young people’s
wellbeing and safety
Have safeguarding policies in place that are appropriate to your
organisation’s work and the project for which you are seeking funding
Have procedures of how to safeguard and promote the welfare of children,
young people and vulnerable adults, including procedures for dealing with
allegations of abuse against members of staff and volunteers
Have effective recruitment and human resources procedures, including
checking all new staff and volunteers to make sure they are safe to work
with children, young people and vulnerable adults
Child Protection Training, whether new or ‘refresher’ training, must be
undertaken within 3 years prior to your application.
Renew criminal record checks at least every three years
Provide child protection training and health and safety training or guidance
for staff and volunteers. This should be in line with your safeguarding
training plan.
Does your organisation meet the above minimum requirements?
Yes
No
Please provide certificates, registration or inspection details (such as
child protection training, OFSTED or Care Quality Commission) to
evidence that you meet the above minimum requirements:
Updated August 2014
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D2
Health and Safety
Are there any health and safety implications relating to this project?
Yes
No
If yes, have you carried out a risk assessment?
Yes
No
Please provide relevant details below:
D3
Insurance
Does your organisation have insurance cover to undertake the project?
Yes
No
Not Applicable
If Yes, please tick below, according to the type of insurance and send a copy of your
certificate(s) with this form.
Public Liability
Contents Insurance
Buildings Insurance
Employee Liability
Other (please specify):
Have you applied for insurance for this event and been refused?
Yes
No
Please provides details below:-
Updated August 2014
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SECTION E – APPROVALS
STATEMENTS OF AGREEMENT
Terms and Conditions
I / We have read and understand the terms and conditions of the Food Bank
Support Fund. We agree to provide all necessary documentation for verification
prior to consideration of funding and to provide regular project feedback and
financial monitoring information as required.
I / We also understand that Wakefield Council could require all or part of the
approved funding to be repaid. This is known as “clawback”. Clawback can be
enforced by the Council where the organisation fails to comply with the terms of
the Application/Agreement and the terms and conditions in the Guidance. The
Council can enforce clawback when the funding has been used for purposes
other than those specified in the application, where duplicate funding is
received by the organisation from other funding bodies or where the
organisation does not provide evidence of spend for all monies approved.
Please note that if you do not sign the declaration below we will not be able to
process your application.
Data Protection Statement
The information requested on this form is required by Wakefield Council to
assess whether or not your request for funding can be awarded.
We understand that Wakefield Council is required by law to protect the public
funds it administers and to this end may use and share the information provided
on this form for the prevention and detection of fraud.
I confirm I have read the above Terms and Conditions and the Data Protection
Statement.
Signature:
Date:
_____________________________________
_____________
Guarantor for Organisation on behalf of: (organisation name)
________________________________________________________________________
Updated August 2014
Page 9 of 11
Checklist
Have you enclosed?
1. A copy of your organisation’s constitution, articles of association, or
memorandum of agreement as outlined at Question A5.
Yes
No
2. Your latest bank statement which must be within the last 3 months.
Yes
No
3. Costings and quotes to support your application as requested at
question B8.
Yes
No
4. Relevant up to date Insurance Certificate(s) (if applicable) as
asked for at question D3.
Yes
No
5. Child Protection Certificate, registration and inspection details (if
applicable) and evidence of Criminal Bureau Records as outlined
at question D1.
Yes
No
6. Letters confirming any other Match Funding as completed at
question B9 and B10.
Yes
No
7. Any further supporting documentation.
Yes
No
Please note that failure to submit the requested documents will result in your
application not being processed and being presented to the Panel for a
decision.
Updated August 2014
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BACS BANK FORM
Please complete the form below and return it with your application form to:
Helen Purvis
Food Banks Support Fund
Communities & Partnerships
Wakefield One
PO Box 700
Burton Street
Wakefield
WF1 2EB
If this is not possible, please provide details of the organisation for which a cheque
can be made payable. Please note cheques cannot be made payable to an individual.
Your organisation’s name
Address
Post code
e-mail address
(if applicable)
Your bank's name
Bank sort code (six digits)
Bank account number
(eight digits)
Account name
This must be in the name of the organisation not an individual.
Authorised signature
The information provided on this form may be shared with other organisations for the
prevention and detection of crime. We will also include your details on our Engagement
Database to make you aware of key events in your area unless you advise us otherwise.
Do you wish to be added to the Engagement Database
Yes / No