Revenue Grant Application Form

Copies of this completed form and any other supporting papers will appear on a Finance & General Purposes Committee Agenda and will be discussed by the Committee in the presence of the press and public.

I DECLARE THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION SUBMITTED ON THIS FORM IS CORRECT. I ALSO DECLARE THAT ANY GRANT AWARDED WILL BE USED SOLELY FOR THE PURPOSES OUTLINED IN THIS APPLICATION. I UNDERSTAND THAT PETERSFIELD TOWN COUNCIL RESERVES THE RIGHT TO RECLAIM THE GRANT IN THE EVENT OF IT NOT BEING USED FOR THE PURPOSE SPECIFIED.

Name of Organisation

Name of Contact

Address of Contact

Daytime Telephone

Evening Telephone

Email Address

Please outline briefly the activities of the organisation

Please give numbers in the organisation who are paid

Please give numbers in the organisation who are volunteers

How many members/beneficiaries live within Petersfield?

Amount of Grant Applied for

What is the total amount being requested?

What maintenance/running costs is the grant being used for?

Has your organisation applied for a grant elsewhere?

Yes No

If yes, please give details

What other fundraising has been done towards covering maintenance/running costs?

You are invited to give any additional information which might assist the council in considering your application

Please state balances in hand at the end of last financial year

Level of unallocated reserves

How much did the group raise last year (e.g. fundraising by the group other than by grant application)?

Attach audited accounts

Attach constitution/rules

Attach Child Protection Policy (where applicable)

Full Name

Position

Do you have a bank account which accepts electronic payments?

Yes No

IN THE EVENT OF A SUCCESSFUL APPLICATION, PAYMENT WILL BE MADE BY BANK TRANSFER.

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