Please read the guidlines before completing this application form
In order to help us evaluate your request for funding please fill in this form as fully as possible and try to answer the questions in the space provided rather than referring to attached documents. It may be that not all sections are relevant to your circumstances. Should you need any further information please contact the Secretary to the Trustees in writing.
NAME OF ORGANISATION: .....................................................................................................….
NAME OF CONTACT:……………………………………..POSITION………………………….
ADDRESS OF ORGANISATION:...............................................................................................................................
TELEPHONE NUMBER: ...........................................................................................................…...
SECTION 1: (Type & Structure of Organisation)
a) What date was your organisation established? ......................................................
(Please provide a copy of
b) Registered Charity Number: ...................................................………… registration certificate)
(Please refer to the guidelines – you must be a registered charity to qualify for consideration)
c) Who is your Governing Body & how many members? ...........................................……….........
(Committee/Board of Trustees/Local Authority etc.)
d) Is your Governing Body paid or voluntary? ……………………………………...........
e) What is your staffing structure? Total number of paid staff .............................
How many of those are part time paid staff? ………………………………………
How many of those are full time paid staff? ………………………………………
How many volunteers do you have (if any)? ......................................……………...
SECTION 2: (Aims & Qbjectives)
a) What are your aims and objectives?………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
b) How many people benefit from your organisation? ....................................................…………….
c) What is the geographical area covered by your work?…………………………………………......
SECTION 3: (Financial Structure)
a) Sources of Income for the Current Year (including confirmed anticipated funds):
Statutory (please first read guideline exclusions) Source(s): ………………………………………………….
Amount: £..................................
Own Fundraising Amount: £..................................
Donations from Individuals Amount: £..................................
Trusts/Corporate Donors Amount: £..................................
Fees/charges for services Amount: £..................................
Legacies Amount: £...................................
Investment Income Amount: £...................................
Net Assets Amount: £...................................
Other (Please also give details) Amount: £...................................
Current Year TOTAL £………………………
b) What WAS your total annual income last year?£........................................
(Based on the accounts for the last financial year – please enclose a copy in addition to completing the details in a) above)
c) Expenditure for the Current Year (including anticipated):
Salaries Amount £..................................…..
Rent/Rates etc. Amount £.................................…...
Administration Amount £..................................…...
Volunteers' Expenses Amount £..................................……
Other (please give details) Amount £..................................……
Current Year TOTAL £…………………………..
d) What WAS your total annual expenditure last year?.........................................
(Based on the accounts for the last financial year – please enclose a copy in addition to completing the details in c) above)
SECTION 4: General Information
How did you hear about the Gay & Peter Hartley's Hillards Charitable Trust?
…………………………………………………………………………………………………………
Have you applied to this Trust for a donation before? If so, please state approximate date
(This information will be verified)………………………………………………
Were you successful? (if so, please state amount received)…………………………………………..
If you are seeking funding for a particular project within your organisation please answer the additional questions below – if not, mark this page “not applicable” then continue on Page 4 from “…Any other Information?….”
SECTION 5: (Project for Which you are Seeking Funding)
a) What are the aims & objectives of this project?…………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
b) Who will benefit?…………………………………………………………………………………..
c) What is it for?………………………………………………………………………………………
d) Is this a new venture?………………………………………………………………………………
e) How do you know there is a need?.…………………………………………………………….......
f) When did/will the project begin?……………………………………………………………….......
g) What is the life span of the project?……………………………………………………………......
h) Once up and running how will the project be evaluated?…………………………………………..
.
i) What is the total cost of the project?…………………………………………
Capital: £..…………………..
Staffing Costs £............................... per annum
Running Costs £.............................. per annum
j) How much funding are you seeking from this Trust?........................…………………………....
(Please refer to the guidelines – maximum one-off donation usually £1,000)
k) How will this funding be used? ....................................................……………………………….
l) How much has been raised so far? ............................……………………………………………
m) By what means?………………………………………………………………………………….
n) How will other revenue costs be met?................………………………………………………...
……………………………………………………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
o) Is the project financially free-standing of your other activities?………………………………..
p) Do you require any additional staff for the project?…………………………………………….
q) If so, how many? .................................................………………………………………………
r) Are the people who will benefit also involved with the development and running of the
project? ………………………………………………………………………………………….
s) If so, how?…………………………………………………………………………………
Any other information?
Signed:…………………………………
Date:……………………………………
All applications, as well as a copy of your charity registration certificate (and any supporting documentation including directions / a location map unless previously submitted) should be returned by 31st December (and certainly as soon as possible to enable a visit to be made if necessary).
Please address all correspondence to:
Secretary to the Trustees
The Gay & Peter Hartley’s Hillards Charitable Trust
400, Shadwell Lane, LEEDS LS17 8AW
N.B. Applications for funding are not acknowledged. If applicants have not received a
reply by 1st May the following year they should assume that they have been
unsuccessful.
(Jan 2003 Version)
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