About the organisation

Organisation name: *

Date established: *

Address: *

Name of main contact: *

Role within the organisation: *

Telephone number: *

Email: *

Website details:

Social media pages:

Please tell us a bit more about your organisation and your aims and objectives:

Do you have a prior connection with Locala or any of Locala’s services? *

Yes

Please tell us about your connection to Locala: *

The project

How much funding are you requesting? (Please note groups must be applying for £1,500 or less) *

Please tell us how your project will contribute to our Social Value Pledges which you identified in section 1

Health and Wellbeing - improve health and wellbeing, reduce isolation and engage with communities to meet their needs. *

Education and Skills - recruit and train people from all our communities, provide opportunities to improve people’s skills, escalate their careers and support them to have better lives. *

Employment - increase inclusive work opportunities particularly within diverse communities. *

Volunteering - increase volunteering which gives a sense of purpose and improves the lives of both volunteers and the people they work with. *

Economic - improve our local economy and the lives of the people within it. Support local charities and SMEs and buy local. *

Environment – reduce carbon footprint and positively improve our local environment. *

Leadership - reduce health inequalities and effect change in equality and diversity. *

Please tell us about what the funding will support. (Details of the project, equipment, etc. that the grant will fund) *

How many people do you expect will benefit from the project and how will they benefit (what changes do you expect the participants to experience/demonstrate)? *

How will you evidence these changes? For example, will you use any recognised measurement tools, survey participants at the start and end of the project, gather data some other way? *

Please provide details of the timescales of the project, including when it will start, when it is estimated to end and when funds will be spent. *

Is this a continuous project? How will you fund the project long term? *

Financial Information

What is the total cost of the project? *

Please attach any existing quotes Upload file

What other funds have been secured (if any)? *

Please provide a breakdown of costs: *

Declaration

The person completing this application and an independent reference must sign the form below. Independent references may be contacted to confirm the details in this application.

We confirm that the information on the form is correct and if a Locala Community Fund grant is awarded it will be used for the purpose detailed in this application. We understand that we will need to provide any additional documentation on request.

Name *

Position *

Date *

Independent Reference

Name *

Address *

Telephone Number *

Relationship to group or organisation *

Membership

We encourage all applicants of the Locala Community Fund to join Locala as Community Members.

Community membership is open to anyone who lives in Bradford, Calderdale, Kirklees, Stockport or Tameside is over the age of 14 and provides an opportunity to find out more about and shape the future of local healthcare. You will receive emails, newsletters and invitations to events giving you the opportunity to get involved and have a say in what happens at Locala.

To sign up as a community member, please visit: https://secure.membra.co.uk/LocalaApplicationForm/ or email [email protected]

Do you consent to us adding the email address provided as part of this application to a mailing list for the Community Fund? *

Yes

Locala Community Fund Application Form 2022/23