DEMENTIA FRIENDLY COMMUNITIES PROJECT
Call for Application to the Dementia Friendly Communities (DFC) Project Award 2015
“Promoting the Participation of People with Dementia in Choirs”
Please read through the guidelines before completing this application form
Applications or queries should be addressed to:
Name:
Telephone:
E-mail:
Website:
Fiona Gallagher, The Alzheimer Society of Ireland, Project Leader – Dementia Friendly
Communities
01 2073802
fiona.gallagher@alzheimer.ie
www.alzheimer.ie
SECTION 1 - CONTACT INFORMATION
1.1 Name of applicant organisation:
1.2 Name of the dementia friendly project - Choir:
1.3 Contact person with overall responsibility for the project
Lead contact person
Name:
Organisation:
Position/Role:
Telephone:
Email:
Second contact person
Name:
Organisation:
Position/Role:
Telephone:
Email:
1.4 What is the structure of the applicant organisation (e.g. community and/or voluntary group, registered
charity, informal group):
1.5 Charity No. (if applicable):
1.6 Briefly describe the work/activities that the organisation is currently involved in (50 words)
1.7 Does the organisation have a bank account?
Yes
□
No
□
SECTION 2 - PROJECT APPLICATION
Please ensure the application is completed using this form, submitted by e-mail in Microsoft word format (see
application guidelines for closing date and contact details) and does not overly exceed 500 words.
There are word limits offered as a guideline for each question and it is suggested that each answer does not
overly exceed these suggestions.
Brief summary of the dementia friendly project being proposed
2.1 Please provide a brief summary (no more than 100 words) of the dementia friendly project that will be
undertaken.
Please note this summary may be used for promotional material in the future.
Description of the project
(scoring 50)
2.2 Give details of the key activities that will be undertaken by the project? (50 words)
2.3 Outline how the proposed project meets the criteria outlined in the guidelines (100 words)
2.4 What activity (if any) has been undertaken to develop this project? (50 words)
Involving people with dementia
(scoring 20)
2.5 Outline how the project will promote the greater inclusion of people with dementia and their families in arts
and cultural life? (100 words)
Working in partnership with the community
(scoring 10)
2.6 Will the project work in partnership with other stakeholders and if so, how? (100 words)
Timelines and Project costs
(scoring 20)
2.7 Outline a timeline for delivery of the project (30 words)
2.8 What is the total amount of funding requested for this award?
_________________________________________
2.9 Provide an outline of the project costs (other lines may be added)
Item
e.g. refreshments
Hire of room
Amount
e.g. €150
€200