Before completing this form please ensure that you have read the Guidelines document. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED AND WILL BE RETURNED TO THE APPLICANT.
THE CLOSING DATE FOR RECEIPT OF APPLICATIONS IS FRIDAY 27TH OF FEBRUARY 2015
Municipal District you are applying to: _________________________________
SCHEME UNDER WHICH ARE YOU APPLYING FOR FUNDING (tick one only):
Capital Grant ____
Amenity Grant ____
GENERAL DETAILS
1(a). Name of group, organisation: ________________________________________
Address: _________________________________________________________________
________________________________________________________________________
Mobile : _________________Telephone:_______________ Fax: ___________________
E-Mail: __________________
1(b). Contact person for this application: ____________________________________________
Position in Organisation: ____________________________________________________
Address, if different from 1(a) above: __________________________________________
_______________________________________________________________________
Mobile: __________________Telephone: __________________ Fax: _________________
E-Mail: ________________
We ask that you tell us immediately if these contact details change.
1(c). What is the status of your group/organisation?
Community Group r
Voluntary Group r
Co-operative r
Limited Company r
Club/Association r
Other (please specify) _________________________________
1(d). When was your group established? _________________________
1(e). Please tell us about your group’s aims, activities and achievements. Completed projects are of particular interest.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
1(f). Grant History:
Please tell us if in the past 5 years you were awarded funding by either Cork County Council or a Town Council:
| Year | Awarded By | Amount | Scheme* | Project ( incl. reference number if available) |
*Community Scheme, Amenity Scheme, Community Contract, other
2. PROJECT PROPOSAL
2(a) Please tell us briefly about your proposed project and particularly
Project background
- Expected outcome
- Facilities to be provided (including scale drawings and specification)
- Potential benefits
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2(b) Please give three indicators by which you will measure the success of your project: e.g. community activity/participation, volunteering, etc.
____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
2(b) How long will this project will take to complete?
Start date: ______________________________ End date: __________________________
2(c) Are you applying for funding under any other Scheme this year? If yes
Funding Scheme ______________________________________________
Project cost €
Amount applied for €
Project details _______________________________________________
___________________________________________________________________
2(d) Funded facilities should be open at all reasonable times to the public or particular groups and either free or at moderate charge. If this is not the case, please tell us why and how you propose to control its use.
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2(e) How does your group plan to maintain/manage this project when complete?
__________________________________________________________________________
_________________________________________________________________________
2(f) Does your group need any additional funding or statutory approvals for this project to proceed? ___________________________________________________________________________
2(g) Does your group own/lease the land or property
___________________________________________________________________________
2(h) Please state how your group proposes to publicly acknowledge Cork County Council’s contribution. As an example your group could involve the Mayor of County Cork or nominee of the Mayor in any official opening
___________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. FINANCIAL INFORMATION
3(a) Total project cost: € ___________________
3(b) Please show the main project costs (Please include supporting documents)
_________________________________________________________ € ____________
_________________________________________________________ € ____________
_________________________________________________________ € ____________
_________________________________________________________ € ____________
3(c) Capital/ infrastructural projects only:
Have you itemised quotations/tenders for all project costs? Yes/No
If the answer is no when will these be obtained? ___________________________________
3(d) Do you have either of the following?
Current Tax Certificate __________
If yes please complete: Certificate Number ________________________
Expiry ________________________
Letter from Revenue Commissioners stating that are/are not registered for VAT __________
4. FUNDING SOURCES
4(a) Please fill out the table below with details of how your group intends to finance this project. Please note that if you are seeking funding for a capital project (building work for example) you should confirm that matching funding is in place. Your application should then include letters of offer from agencies or group bank statements showing funds.
Funding |
Agency |
Applied for or already secured |
Approved |
| Expected/Applied for or Received Grant Aid
Funding from any other source. |
(1)
(2) (3) (4) |
€
€ € € |
€
€ € € |
| Borrowings | Source: | € | € |
| Fundraising | Source: | € | |
| Own Funds | Source: | € | |
| Others | Source: | € | € |
| This grant application | Cork County Council | € | |
| Total | Must equal total cost of project | € |
GRANT PAYMENT
5(a) Please provide the following relating to your group so as allow us to arrange payment of your grant.
PPS number __________________________
or
Employer tax registration number & Tax District __________________________
or
VAT registration number __________________________
5(b) Unfortunately we cannot allocate grants to any group that owes money to Cork County Council such as rates or planning fees. If you are currently paying such charges please include the account numbers in the spaces below.
Planning Fees _________________________________
or
Rates _________________________________
or
Other charges _________________________________
6. DECLARATION
I declare the information given above to be accurate and that our groups tax affairs are in order.
SIGNED: _____________________________________
TITLE: ______________________________________
Date: ___________________________________
Community Contract Application Form
Before completing this form please ensure that you have read the Guidelines document.
INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED AND WILL BE RETURNED TO THE APPLICANT.
Municipal District you are applying to: _________________________________
GENERAL DETAILS
1(a). Name of group, organisation: ________________________________________
Address: _________________________________________________________________
_______________________________________________________________________
Mobile: _________________Telephone:_______________ Fax: ___________________
E-Mail: __________________
1(b). Contact person for this application: ____________________________________________
Position in Organisation: ____________________________________________________
Address, if different from 1(a) above: __________________________________________
________________________________________________________________________
Mobile: __________________Telephone: __________________ Fax: _________________
E-Mail: ________________
We ask that you tell us immediately if these contact details change.
1(c). What is the status of your group/organisation?
Community Group r
Voluntary Group r
Co-operative r
Limited Company r
Club/Association r
Other (please specify) _________________________________
1(d). When was your group established? _________________________
1(e): Approx how many volunteers are involved? __________________________
1(f). Please tell us about your group’s aims, activities and achievements. Completed projects, awards etc are of particular interest.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
1(f). Grant History:
Please tell us if in the past 5 years you were awarded funding by either Cork County Council or a Town Council:
| Year | Awarded By | Amount | Scheme* | Project ( incl. reference number if available) |
*Community Scheme, Amenity Scheme, Community Contract, other
2. CONTRACT PROPOSAL
2(a) Please tell us briefly about your proposed contract and particularly
Expected outcome
- Potential benefits
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
2(b) Please advise if you have had initial discussions with the Area Engineer in relation to the proposed contract works. If you have not met when is it proposed that this will take place?
___________________________________________________________________
___________________________________________________________________
FINANCIAL INFORMATION
3(a) Total contract cost: € ___________________
3(b) Please show the main project costs (Please include supporting documents)
_________________________________________________________ € ____________
_________________________________________________________ € ____________
_________________________________________________________ € ____________
_________________________________________________________ € ____________
3(c) Do you have either of the following?
Current Tax Certificate __________
If yes please complete: Certificate Number ________________________
Expiry ________________________
Letter from Revenue Commissioners stating that are/are not registered for VAT __________
GRANT PAYMENT
4(a) Please provide the following relating to your group so as allow us to arrange payment of your grant.
PPS number __________________________
or
Employer tax registration number & Tax District __________________________
or
VAT registration number __________________________
4(b) Unfortunately we cannot allocate grants to any group that owes money to Cork County Council such as rates or planning fees. If you are currently paying such charges please include the account numbers in the spaces below.
Planning Fees _________________________________
or
Rates _________________________________
or
Other charges _________________________________
5 DECLARATION
I declare the information given above to be accurate and that our groups tax affairs are in order.
SIGNED: ___________________________________________
TITLE: ___________________________________________
Date: ___________________________________________