Community Impact Fund Application form

Please complete the application form below. You can't save your application, so you will need to complete this form in one go.

A young woman sat at a desk with a laptop

We have tried to make the application form as easy as possible to fill in. If something is not clear, please contact the Community Involvement & Investment team by emailing communities@greensquareaccord.co.uk.

About you and your group/organisation

Name of group *

Address *

Postcode *

Contact name *

Email address

Telephone number *

What is your role/responsibility within the group? *

What does your group/organisation do? *

Please tick this box to confirm that your group/organisation is constituted *

I confirm that my group/organisation is constituted

Attach a copy of your latest annual accounts/report. If your group or organisation is new, a draft or income and expenditure forecast will be sufficient.

Attach a copy of your public liability insurance details

Attach a copy of your employers' liability insurance details

Please explain if/why any of these documents are not available

About your project

Project name *

Project location *

Project start date *

Project end date *

Which of our key themes does your project align with? *

Employment and skills

Financial capability

Digital inclusion

Health and wellbeing

Project description *

How do you know that your project or idea is needed locally? *

How many GreenSquareAccord customers will the project impact? *

What are your anticipated project outcomes? *

How will you let the wider community and public know about the project work you are doing and how will you get them involved? *

Funding details

Total cost of the project *

How much are you applying for? *

Which other organisations are supporting your project, financially or otherwise?

What will this funding pay for? *

How much of the funding is already secured? *

What would happen if you did not receive funding from GreenSquareAccord? *

Confirmation statement

Please confirm this statement *

I confirm that the information given in this application is a true statement and that I am authorised to make this application on behalf of the group/organisation.

Signed *

Date *

On behalf of (group/organisation): *

Privacy

We need your consent to store and process your personal information to review your application. Your personal information will be processed in line with our privacy notice. We will not share your personal details with any third parties.

Consent for storing and processing submitted data *

Yes, I give permission to store and process my data

Disclaimer

As funds are limited not all applications will be successful and the judging panel's decision will be final. Completing this application form is not a guarantee that you will receive funding. Please do not allocate money to a project until you have received confirmation that it has been approved.