Community Grant Scheme
Application Form 2012

Please take time to read the guidelines and have all the necessary documents to hand before starting to complete your application.

Sections marked with a * must be completed

Your Group/Organisation

	Group / Organisation Contact Details
	Group/Organisation Name*
	Street Address* (eg 1 High Street)
	Town*
	Postcode*
	Daytime Telephone Number*
	Evening Telephone Number
	Fax Number
	Website Address

	Main Contact for the Group/Organisation*
	Full Name
	Email Address

Is the main contact address the same as the address above?*

Yes

	Main Contact Address
	Street Address (eg 1 High Street)
	Town
	Postcode
	Daytime Telephone Number
	Evening Telephone Number
	Fax Number

What type of group/organisation are you?*

Charity

Company Limited by Guarantee

Constituted Voluntary group

Other

	If you choose 'Other', please specify here

	Please give your Charity Registration Number (if applicable)

We would like to see a copy of the group's/organisation's set of rules. For example, trust deed, constitution etc. Please email these documents to grants@dartford.gov.uk

	Briefly describe the main purpose/activities of your group/organisation*

Your Project

	Basic Project Details
	Start Date (DD/MM/YYYY)
	End Date (DD/MM/YYYY)
	Total Expected Cost*

	Please give a brief outline of your project. Please be specific on what you will do, how you will do it, what you will spend the grant on and what difference it will make*

Banking Details

	Please provide the group/organisation banking details*
	Account Name
	Sort Code
	Account Number
	Bank Name
	Branch Address
	Postcode

Declaration

I certify to the best of my knowledge that the information provided on the form and the emailed supporting information is correct.

I agree to spend the grant provided under the Dartford Community Grant Scheme on elements of the project/activities stated in this application. I will provide receipts as proof of expenditure and agree to complete an evaluation form.

I have read the grant criteria and conditions and agree to abide by them*

I confirm the above

	Person making this submission*
	Full Name

Is your address the same as the group/organisation address?*

Yes

	Address of person making this submission
	Street Address (eg 1 High Street)
	Town
	Postcode

	Date form submitted (DD/MM/YYYY)

In accordance with the Data Protection Act 1998, the information on this form will only be used for the purpose for which it is collected unless you consent to receiving information about Council Services, events and other Council related information *

I consent to receiving information about Council Services, events and other Council related information and understand that I may withdraw my consent at any time

I do not consent to receiving information about Council Services, events and other Council related information

Community Grant SchemeApplication Form 2012

Please take time to read the guidelines and have all the necessary documents to hand before starting to complete your application. Sections marked with a * must be completed

Community Grant Scheme
Application Form 2012

Please take time to read the guidelines and have all the necessary documents to hand before starting to complete your application.

Sections marked with a * must be completed