Online Application

Section 1: PERSONAL / ORGANISATION DETAILS

Name of individual / organisation

Name of contact person and position in organisation

Address of your organisation / key person with responsibility for the project, along with the postcode

Contact details of the person who has responsibility for the project

Home Tel.
Mobile
E-mail

Describe what kind of organisation it is. Charity Number / Company Number (if applicable)

Is membership of your organization / project team open to anyone wishing to join?

YesNo

If No, please explain why.

How many paid staff do you employ?

Employed - Full Time
Employed - Part Time
Volunteers

Section 2: Details of your project

Describe your proposed project. What do you want to do?

Which of the aims of Elusen Dyffryn Peris does your project fulfill?
Identify all that apply.

Who is on your project team?

What benefits will the community bring to your project?

What evidence do you have that the project has support within the community?

How this grant will help you reach your goal?

Will project management be transferred to another body on completion of the project?

YesNo

If Yes, please indicate who will take control of the project and provide evidence that they are willing to do so.
If No, please indicate who will be responsible for project management.

What is the proposed start date of the project?
What is the proposed end date of the project?

section 3: project financial details

Expenditure
Cost £
VAT £
Total £
Total Project Costs

Have you applied for funding from elsewhere?

YesNo

If the answer is No, please give a reason.
Please list any funding bodies contacted and the amount of funding requested.

Name of funding body
Amount £
Total amount of money sought from Elusen Dyffryn Peris (SCE).

Is your organization registered for VAT?
If Yes, you are expected to claim a VAT refund on your project and any grant paid will not include the VAT element.

YesNo

To be completed by the representative of the organisation / group.
I confirm that the information on this form is true and accurate.
Name of Representative
Position
Tel.
E-mail
Date

Section 4: Project Checklist

The following documents should be included as part of your application, if applicable. Please email the documents to
cais@elusendyffrynperis.cymru

- A copy of your organisation’s Constitution
- Written estimates
- Copy of your latest available Accounts
- Bank Statement
- Evidence / letters of community support for the project
- Copy of planning permission or consent to alteration of listed building
- Evidence of adoption of the project by another body

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