Up to two A4 pages of additional information may be provided with this application form only.

Please keep your application as simple as possible and avoid the use of technical terms, acronyms and jargon.
Please do not send booklets, copies of your organisations policies or electronic media such as DVDs or CDs. Applications should be accompanied by a copy of your most recent audited accounts and a detailed budget for the project.

Charity Grant Application Form

Please apply by filling out the details below.

Page 1 of 9

Basic Information

Name of Organisation applying for grant?*

Legal Status of Applicant Organisation

Charity Number

Details of governing body

Upload your organisation's governing document or constitution

Details of governing body and members

Details of Other Organisation

Main Contact Information

Full Name*

Position / Title*

Address*

Please Include Full Address inc Postcode

Main Contact Email*

Telephone No*

Organisation Website

Main Contact Information

Please give a brief description of your organisation*

No of Employees*

Total Annual Income*

Total Annual Expenditure*

Sources of income (including statutory sources, local authority, etc.)*

Application Basic Info

Application Title*

Total Amount Requested*

Please provide a brief description of how the funding will be used.*

Please limit your answer to 200 words. Please outline how your organisation will carry out the proposed work. If the funding is for a particular project, please give details of the scope of the project including the number of staff and volunteers involved. If not for a specific project then please give details of costings within your core budget.

Please provide an outline of the need for this funding/project (using evidence where possible)*

Please outline how your application for funding relates to the relates to the needs of your beneficiaries, and provide as much evidence in 200 words. If the funding is for a particular project, please demonstrate how the project is a direct response to a need (or needs) that you have indentified. This might include a shortfall amongst other similar service provisions, the absence of a required service in your area or a change in circumstances amongst your potential beneficiaries. If the funding is not for a particular project (i.e. core costs) please summarise how your organisation meets needs in your area.

Please provide details of who will benefit from your funding request.*

Please limit your answer to 200 words. Please privide as much detail as possible regarding who will directly benefit from this funding (this might include an estimate of the number of beneficiaries, the age of beneficiaries or the location of the services provided).

Please explain how the application fits within our mandatory criteria (as detailed on our website):*

Please limit your answer to 300 words. This question asks you to demonstrate how this application fits your own charitable objectives, as well as with the Halsall funding criteria.

Outcome Assessment

Please list up to 4 outcomes that you expect to result from this grant: The Halsall Foundation defines an 'outcome' as the direct results to the service delivery and beneficiaries of the organisation that receives a grant from the Charity. In answer to this question, we simply ask that you list what you expect to come out of this grant in order to judge it a success. We will ask you to report against these measures at the end of your grant, or each year, whichever is sooner. Your list may include both qualitative and quantitative outcomes. Example outcomes might include:

assist 5 people to meaningful employment
provide housing/benefits/debt advice to 45 people
start a new volunteer support group in a North West or Highlands location

Expected Outcome 1*

Expected Outcome 2*

Expected Outcome 3*

Expected Outcome 4*

Please provide details of how you intend to measure each of the outcomes of this funding (listed above)*

Financial Details

Application as a percentage of the total budget*

Please upload a budget breakdown for the application*

Maximum size 10MB. PDF, DOC, TXT only please

Please provide details of other funding applied for*

Deadline for funding request (if applicable):

Please upload latest signed and audited financial accounts*

Maximum size 10MB. PDF, DOC, TXT only please

Additional Information

Does your organisation have any other connection with the Halsall Foundation such as previous funding, sponsorship or tenancy relationship?*

Where did you first hear about the Halsall Foundation?*

Upload your Photograph

Please upload a photograph or photographs (optional). Maximum size 10MB. PDF, DOC, TXT only please

How would you like to be contacted?

Home / office

Mobile / cell phone

Mobile Tel

Home Tel

Email address*

Any Further Information to help with your application?

This field should be left blank

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HELPING CHARITIES ALL ACROSS LANCASHIRE
ACHIEVE THEIR OBJECTIVES

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Charity Grant Application Form

Basic Information

Main Contact Information

Main Contact Information

Application Basic Info

Outcome Assessment

Financial Details

Additional Information

How would you like to be contacted?

GET IN TOUCH

HELPING CHARITIES ALL ACROSS LANCASHIRE ACHIEVE THEIR OBJECTIVES

HELPING CHARITIES ALL ACROSS LANCASHIRE
ACHIEVE THEIR OBJECTIVES