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| Sports Grant Application Form |
Required fields are marked
with an "*"
asterisk. Please use the TAB key to navigate through fields.
(SHIFT+TAB) will move backwards.
Pressing ENTER will automatically submit the form (once required fields
are filled). |
|
| Your Details |
| Name of Group: |
* |
| Name of contact person: |
* |
| Your role within the Group: |
* |
| Address: |
*(House name / number) |
|
*(Road / Street) |
|
*(Town / City) |
*(Postcode) |
| Telephone: |
*(day) |
(eve) |
| Email: |
|
Fax: |
|
|
| Demographics |
| Where do your activities normally take place? |
* |
name the venue(s) |
| How many members do you have? |
| Male: |
* |
Female: |
* |
Junior: |
* |
| How many members will benefit from this application? |
* |
| Where do the majority of your members live? |
* |
(which parts of Copeland?) |
| Does any group or individual within your organisation profit financially as a result of your activities? |
* |
| If yes, please give details: |
|
| For what purpose do you require a Sport Action Zone grant and who will benefit? |
* |
|
| Criteria |
| How does your community group or club fulfil any of the following criteria? |
| Consultation |
|
| How does your project represent what local people want and need? |
| Concessionary Pricing |
|
| How are you going to make your facilities affordable to those on low incomes? |
| Pro-active Marketing |
|
| How will you let people know about your sports activities? |
| Sporting Partnerships |
|
| What links have you made with other organisations in the area that have an interest in sport? |
| Access |
|
| Do you have an open membership policy where anyone from the local community can easily become a member? |
| Transport |
|
| How will people travel to the sports facilities you offer? |
| Your Organisation |
|
| Is your image one that welcomes everyone? |
| Equipment |
|
| What arrangements will you make for those who cannot afford to buy their own equipment? |
| Involvement |
|
| How will you involve people in the running of your project? |
|
| Requirements |
| Please list below the equipment and/or services
required and costs: [by item] |
| 1:
|
* Cost (£) |
| 2: |
|
| 3: |
|
| 4: |
|
|
* Total Cost (£) |
| What contribution towards these or associated costs have your group made? £ |
* |
| What contributions have been made towards these costs by others? £ |
* |
| Who by? |
* |
| What contributions are you seeking towards these costs from others? £ |
* |
| From whom? |
* |
| How much are you requesting from the Sport Action Zone? £ |
* |
| Please remember this figure must not exceed £500 or the application will not be considered. |
|
| Dissolution |
| What would you propose happens to the equipment if your group disbanded/ceased to exist? |
* |
|
| Suppliers |
| Please include name and contact number details for your preferred supplier(s) relevant to the items listed earlier. We may ask you to send quotes, estimates or price lists to confirm the costs. |
| We reserve the right to place the order with an alternative supplier. |
| Item |
Supplier's Name |
Contact Number |
Cost |
| 1: |
|
|
£* |
| 2: |
|
|
£ |
| 3: |
|
|
£ |
| 4: |
|
|
£ |
|
| Referee |
| Please give the name, address and telephone number of someone who is willing to act as a referee for your group (if required). This might be a local Councillor, MP, member of the clergy, qualified sports coach, community worker, youth worker or Sports Development Officer, Doctor or similar |
| Name: |
* |
Role: |
* |
| Address: |
* |
| Daytime Tel No: |
* |
|
| Declaration |
| In submitting this application I agree to the following: |
| 1. If successful I agree to provide a report to the panel within 2 months of receiving the grant and to co-operate with publicity and promotions naming the Sport Action Zone and Copeland Borough Council if at all possible. |
| 2. I will supply any further information in support of this application as requested by the Sport Action Zone and Copeland Borough Council in as timely a manner as possible. |
| 3. I confirm that the information given on this form is true and correct and that I have been authorised by the members of the group I represent to make this application on their behalf and I agree to this information being held on a database and used by the Sport Action Zone and its partners for further sports and health development. |
|
This application will be submitted to:
Kim Wilson, Copeland Borough Council, Whitehaven Commercial Park, Moresby
Parks, Whitehaven, CA28 8YD Telephone 01946 852896 |