APPLICATION FOR A CHURCH GRANT – AUTUMN 2017 ROUND

Closing date: 5.00pm Monday 16th October 2017

Late applications may not be considered

Please read the Autumn 2017 version of the Guidance Notes and Frequently Asked Questions before completing the application.

Please email your application in Word (and any necessary attachments that you have electronic copies of in whatever format you have) to grants@cloudesley.org.uk and then post the signed copy of the ‘Declaration and Checklist’ page only with any accounts, estimates etc for which you only have hard copies. Please see notes at the end of this form.

Section 1: Your Church

1.1 Name of Church: 1.2 Deanery ID:

1.3 Name of Contact Person for this application:

Position/role in the Church:

1.4 Address for correspondence:

Post Code:

Telephone No:

1.5 Email:

1.6 What is the total number on the electoral roll for the church in this application? Electoral Roll number: At date:

NB – if part of a team/group, please answer for this church only

1 Application Form Autumn 2017

A charity endowed by the Will of Richard Cloudesley on 13th January 1517 serving churches and health and welfare needs in the London Borough of Islington. Richard Cloudesley Trustee Limited Co. Reg. No. 7425897 Charity Commission Reg. No. 205959

Office 1.1, Resource for London, 356 Holloway Road, London, N7 6PATel: 0207 697 4094 Email: admin@cloudesley.org.uk

www.cloudesley.org.uk

1.7 What is the average number attending your main Sunday service over the past three months:

Period:

Average number - adults: Average number – children:

Please state whether these numbers are increasing, decreasing or reasonably static

1.8 Staff members and volunteers:

Number of full time staff:

Number of part time staff:

Number of volunteers:

Please provide a summary of key staff and volunteer roles

1.9 How many people use the Church premises?

Please complete the table below, listing the groups which meet in your premises (Church and Church Hall etc) with an estimate of attendance

Church or Church Hall?

Group Name Frequency

Please state regularity (e.g., weekly, monthly) and how often (e.g., 52 weeks per year)

Number of adults

Average per session

Number of children

Average per session

For example: Church Hall

Brownies Weekly for 39 weeks per year

3 15

1.10 On what days and hours is the Church open to visitors?

Days: Hours:

2 Application Form Autumn 2017

Section 2: Your Project/Works

2.1 Brief summary of purpose for which funds are requested:

This should describe what the money is to be used for (50 words maximum)Reasons and benefits should be set out elsewhere.

2.2 Total Project/Works Cost: £

Amount Requested from Cloudesley towards this: £

2.3 Funding Stream applied to:

For details of each of the Charity’s funding streams, please see the Guidance Notes. Please tick one of the following to indicate which funding stream you are applying to.

Capital and major developments

Enabling major developments

Substantial repairs, refurbishment and equipment

Capacity building

2.4 Details of the work to be funded

Describe the need for the work/project and how the need was assessed.

What will be provided and who will do the work?

3 Application Form Autumn 2017

What do you aim to achieve? How will that advance the mission of the Church to the people of Islington?

Why are you applying for funding now for this work/project?

2.5 Project/works timescales relating to this funding request

Expected start date for the project/works (month/year):

Expected finish date for project/works (month/year):

2.6 Planning, faculty and other consents

If any planning, faculty or other consents are required for the project to proceed, please provide details and indicate what stage have the applications reached.

2.7 Consultation

If relevant, please give details of any consultation that has been/will be carried out in relation to this project/work. Please include a summary of any concerns/issues raised and how these have been/will be addressed.

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2.8 Impact and effectiveness

How will you review and measure the impact and effectiveness of the work/project?

2.9 Beneficiaries

How many people are expected to benefit from this grant over 12 months?

Who will benefit from this grant?

Please provide a breakdown of the anticipated ages and gender of beneficiaries

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Section 3: Finances

3.1 Project / works budget Please ensure you:

Complete every section of the table below List each item or activity included in the whole of the project/works (not just those elements for which

you are seeking funding from Cloudesley) Indicate VAT where applicable

If you have any questions about this table, please contact the Charity’s office.

EXPENDITURE:

A. Project / works

Please list each item of the project / works separately

B. Cost excluding VAT (£)

C. VAT (£)

If applicable

D. Total cost (£)Sum of columns B + C

£ £ £

£ £ £

£ £ £

£ £ £

£ £ £

£ £ £

TOTAL PROJECT/WORKS COST: £ £ £(Fig. 1)

INCOME – CONFIRMED:(Income already raised)

Funding source Amount raised (£)

Is this funding towards a specific item from the expenditure list above, or a general contribution towards the total project cost?

Please state specific items where applicable

Church fundraising £

Church reserves £

Church – other (please state) £

Loan – London Diocesan Fund £

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Loan – other (please state) £

Other funder (please state) £

Other funder (please state) £

TOTAL INCOME ALREADY RAISED: £ £(Fig. 2)

Previously awarded from Cloudesley this project/works:Amount(s) previously awarded by CloudesleyOnly enter previous awards related to this project/works

£(Fig. 3)

Granted towards (please state specific items):

INCOME – POTENTIAL:(Income applied for but not yet confirmed)

Amount requested now from Cloudesley towards this project/works:Amount requested in this application (Autumn 2017)

£(Fig. 4)

Requested towards (please state specific items):

Other funders currently considering your proposal:Funder / source

Please state the name of each funding source

Decision date

Please state the expected decision date for your application

Amount requested (£)

Is this funding towards a specific item from the expenditure list above, or a general contribution towards the total project cost?

Please state specific items where applicable

£

£

£

£

TOTAL OTHER FUNDING APPLIED FOR:

£(Fig. 5)

VAT recovery:Listed Places of Worship Scheme £

(Fig. 6)Requested towards (please state specific items):

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BUDGET SUMMARY:Please insert the expenditure and income figures from your breakdowns aboveEXPENDITURE:Total project / works cost (Fig. 1) £

(Fig. 1)

INCOME - confirmed:Income already raised (Fig. 2) £Previously awarded by Cloudesley (Fig. 3) £Total confirmed income: £

INCOME - potential:Requested from Cloudesley Autumn 2017 (Fig. 4) £Other funding applied for (Fig. 5) £VAT recovery (Fig. 6) £Total potential income: £

TOTAL INCOME (confirmed + potential): £(Fig. 7)

SHORTFALL OR SURPLUS (Fig. 7 – Fig. 1): £

3.2 Reserves What level of unrestricted reserves (both general and designated funds) do you have? Please indicate how much of this is held as fixed assets.

How much of your reserves can be applied to the project/works for which you are requesting this grant? (Listed under ‘Income already raised’ above).

If you have designated funds, please explain the purpose of each designation.

3.3 Shortfall or surplus Taking into account the information in the Budget Summary table above, please explain how any shortfall or surplus will be managed.

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Section 4: Declaration and Checklist

Declaration to be signed on behalf of the Church

Name of Church:

To the best of my knowledge, all the information that has been provided in this application form is correct

The project/works for which funding is sought has been considered and is supported by the PCC

Sharing information:

I understand that the information provided as part of this application may be shared by the Charity with other funders and relevant parties. I also understand that the Charity may approach other funders and other relevant parties to discuss this application as part of the assessment process.

Signature of Applicant/Contact on page 1 Counter-Signature by Vicar or Churchwarden

Signed: Signed:

Print name: Print name:

Position: Position: Vicar Churchwarden

Please note: in the case of a team parish the counter-signatory should be the same signatory as that of the summary provided which indicates the priority of all applications for the parish (see “Guidance Notes – Other Information”)

Date: Date:

Checklist – please check the following points have been completed:

Answered all the questions in the spaces provided Annexed your most recent signed, audited or independently examined accounts (if not

previously supplied)

Annexed any estimates or quotes, plans and permissions (as requested in the Guidance Notes)Annexed evidence which shows that the planned works/project and this funding application have been discussed and agreed by the PCC

Completed the Declaration on behalf of the applicant Church with two signatures and the Checklist

Retained a copy of the application form For a team: provided a summary covering the priorities for the parish (see Guidance Notes –

Other Information)

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The full application should be emailed as a Word document, together with any necessary attachments, to grants@cloudesley.org.uk by 5pm on Monday 16th October 2017

A hard copy of the above declaration must then be printed, signed and posted, (together with any supporting documents for which you only have hard copies available)

to reach us by 5pm on Thursday 19th October 2017:Cloudesley

Office 1.1, Resource for London356 Holloway Road, London, N7 6PA

Revised September 2017

10 Application Form Autumn 2017