Partner Grant

We recommend that before starting this application form, you read the guidance documents that are available on the website.

If you struggle to fill in any section of this form please look at the guidance document or contact: [email protected]

Starting your application

You must tick all boxes below to confirm that:

You will answer all applicable questions in this application form.
You are authorised to apply for a grant from us on behalf of your organisation.
You understand that if you make any seriously misleading statements (whether deliberate or accidental) at any stage during the application process, or knowingly withhold any information, this could make your application invalid and you could be liable to repay any funds to us.
You agree to the Data Protection arrangements on page 12.

Part One: Eligibility

Please answer all of the below:

Does your organisation provide a service to residents in Stoke-on-Trent?
Does your organisation have a registered bank account with two signatories who are not related and don’t live at the same address?
Is your organisation already receiving funding from the Community Health Champions project?
Will you commit to at least two people from your organisation fully completing Community Health Champion training and remaining fully active as a Community Health Champion for one year?
Be committed to supporting and promoting the Community Health Champions project and the positive health messages it provides?

Unfortunately you do not quilify for this grant at this time, for more information please contact: [email protected]

Part Two: About you and your organisation

Organisation’s name *

Address line 1 *

Address line 2

Address line 3

City *

County *

Postcode *

Website address

Charity number (if applicable)

Who is the main contact for the application?

(Please note the contact details you list below will be the details we contact regarding the result of your application)

Position in organisation *

Title

First name *

Last name *

Email *

Telephone Number *

Alternative address if different from above (including postcode):

What is the structure of your Organisation?

Please specify *

Which Community(ies) of Stoke-on-Trent do you represent or have reach into? (You can write up to a maximum of 50 words)

How will your organisation actively seek to spread the positive health messages of the Community Health Champions project to this community? (You can write up to a maximum of 150 words)

Are you aware of similar provision already available in your community? If so, how can you differ from / complement this? (You can write up to a maximum of 150 words)

How much funding do you require? * (Maximum £5,000, remember to include VAT)

Checklist:

Please email the following to [email protected] as soon as you complete your application. If all the requested information is not sent, your application WILL NOT be accepted.

Please put the name of your organisation in the subject field of your email. You will then receive an email confirming that we have received your submission.

  • * Your governing document (this could be your constitution or Memorandum and Articles of Association)
  • * Your most recent set of annual accounts (if you are a new organisation and do not have accounts please contact [email protected]
  • * A recent bank statement (dated within the last 3 months. This must match the details provided earlier)
  • * A copy of your Child Safeguarding Policy (if you require one)
  • * A copy of your Vulnerable Adults Policy (if you require one)
  • * Verification that you either have (or will) have Public Liability Insurance covering in place of no less than £5 million
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