Sample form

Please complete the questions

Applicant organisation or business name

Your full name

Your role in the organisation

Website address

Please provide a brief description about your organisation (max 50 words)

(max 50 words)

Does the organisation have its own bank account?

Yes No

Does your organisation have at least two unrelated signatories?

Yes No

How is your organisation managed?

Board of Directors Trustees Management committee Council

Which of the following does your organisation have in place?

Public liability insurance Professional indemnity insurance Safeguarding Policy Equality & Diversity Policy Health & Safety Policy None of the above

Organisation income in the last financial year

Do you have a written governing document with clearly defined aims and objectives that is properly approved by your management committee/board of trustees/governing body?

Yes No

Please provide a breakdown of project costs

Item and Cost

Please provide a breakdown of project costs

How much of funding has been secured/applied for from other sources?

Project summary (Tell us what the project you are crowdfunding for aims to achieve (Max 100 words)

Where will your project activity take place?

How many volunteers support the organisation?

How many staff are in the organisation (FTE's)?

Please provide your organisation or charity registration number (if applicable)

Tick this box to confirm that you have read and met the full eligibility criteria and agree to the Terms and Conditions

I declare that the information supplied in this application is true. I agree that, if this application is successful, any grant money received will be used for the purposes described in this form and in accordance with the Terms and Conditions. I confirm that I am duly authorised and empowered to confirm this on behalf of the applicant group.

I agree that, if my application for funding is successful, I will complete an impact report on the outcomes of my project.

Confirm that you have read and agree to PARTNER NAME privacy policy.