PAG First Time Access Fund Survey

Before completing this form please ensure you have read the funding guidance notes and criteria.

You may wish to discuss the outline of your project with a member of staff from Barnet Homes for some initial feedback before submitting your application.

About your group

Name of your Group:

Main contact:

Position in group:

Address:

Postal code:

Email address of main contact:

Main telephone number:

Borough ward:

About your project

Project Title:
Give your project a short title so it can be easily identified (Max 10 words)

Project Summary:
Please describe your project and what it seeks to achieve (include the aims of the project and where it will take place) (No more than 150 words):

Which priority does this project address & how does it meet the funding criteria?

The local community
Who are the main beneficiaries? (Please tick all that apply).

Other (please specify)

How many people will be involved in organising and running the project?

What is the start date for the project and when will it be completed by?

Start date:

End date

Project Budget
Breakdown by cost activity:

Total project budget (£)

How much are you applying for? (£) maximum £750

Breakdown by cost activity:

Item 1

Item 1 cost (£)

Item 2

Item 2 cost (£)

Item 3

Item 3 cost (£)

Item 4

Item 4 cost (£)

Item 5

Item 5 cost (£)

Item 6

Item 6 cost (£)

Other items

Other items cost (£)

Total (£)

Payment of Grant – Bank Details

If your application is successful the grant will only be paid into a constituted groups account. If you are applying as a non-constituted group alternative arrangements will be made on an individual basis on how the grant payment will be made.

Are you a constituted group with its own bank account?

Yes

No (Alternative payment arrangements to be made)

Undertaking

We (the named signatories below) declare that the information given in this grant application and accompanying documents are accurate and understand that the information provided will be stored electronically and will be subject to the provisions of the Data Protection Action 1998. By signing this privacy statement I give Barnet Homes permission to use my information in accordance with this privacy statement, The full Barnet Homes privacy policy can be found at www.barnethomes.org/privacy-policy

Date: DD/MM/YYYY

Details of First signatory (lead person)

Name:

Position in organisation:

Email Address:

Phone Number:

Details of second signatory (another member of group)

Name:

Position in organisation:

Email Address:

Phone Number:

To request a copy of your completed application form please email getinvolved@barnethomes.org

For office use only

Date application received

Date application checked

Date reviewed by panel

Application successful

Yes

No

Date approved: DD/MM/YYYY

PAG First Time Access Fund

Application Form