Area Member Panel Opportunities Fund Application Form Name of your group or organisation

Area Member Panel Opportunities Fund Application Form
Name of your group or organisation


Type of group (if the application is not submitted by a Councillor):
☐Residents Group ☐Community Group/Club ☐Registered Charity ☐Parish Council
If Other, please explain: ☐





Which Area Member Panel are you applying to?




When was your group or organisation set up?
What does your group or organisation do?






Name of main contact for the group or organisation:
Address of main contact:







Phone number:




Email address
How much money are you applying for?

(Minimum £50 – maximum of £10,000)

What will you spend the money on?


Are you getting funding from other sources for this project? If so, state the amount of funding received, what it is being used for and where it is coming from.




When will your project start?

When will your project finish?
The project must start within six months of the Area Member Panel’s decision to award funding and must be completed within 18 months of the decision date.
Your project will need to contribute to the following eligibility criteria. Tick all the relevant criteria your project meets and explain how.

1. 
   ☐Relate to city council functions
   

2. 
   ☐Promote or improve the economic, social or environmental wellbeing of the area
   

3. 
   ☐Does not require any on-going revenue support
   

4. 
   ☐If in receipt of other city council funding, can demonstrate that this proposal provides something different or extra.
   

5. 
   ☐Benefits the local community over private individuals
   

What records will you keep about your project (for example attendance sheet, membership list)? The council will request evidence of expenditure being incurred for the project outlined in your application.



Please state the level of unrestricted reserves your organisation has for this year

☐To the best of my knowledge all the information is true.

This form has been completed on behalf of INSERT NAME OF GROUP OR ORGANISATION
By INSERT NAME
On INSERT DATE

Please return this form with the following and tick to confirm they are attached or have been sent:
☐BACS Form (If you are not successful we will destroy this information)

Return the form to Democratic Services: [e-mail]

(When doing so, please rename the file with the name of your group or organisation.)
If you have any questions regarding the Opportunities Fund, please contact:
Richard Griffiths

01227 862 525

[e-mail]