Company and Charity no (if applicable)
Company: (*applications are accepted from organisations that operate for charitable, community or social purposes operating on a non profit basis)
Name of contact person*
Job Title of contact person*
Daytime landline number
We have read and accept the Grant-Making Policy of the Charity* (found here)
Title of project*
Brief description of project (maximum 400 words)*
Which areas of Teesside will your project benefit?*
Purpose of project (maximum 100 words)*
Please state how you believe the project will benefit the public/community*
Length of project*
Expected start date*
Expected finish date*
How many people will benefit this project/funding?*
Amount of funding being requested from Charity*
Please provide a breakdown of requested funding:*
Will any of the funding be used to meet your organisation's core operational costs/overheads?*
If yes, how much
Total cost of project*
Please provide a detailed breakdown of the full project:*
Are you seeking a one-off payment?*
If no, please provide further details
Please tick the following to indicate the charitable purpose(s) for which you seek funding:
education youth groups poverty health environment relief of need disability citizenship/community development arts, heritage, culture or science amateur sport human rights/conflict resolution armer forces or emergency services
Do you wish the grant to be paid directly to your organisation?*
If no, to whom would you like the grant to be paid?
If successful, who do we make a cheque payable to?
Will your organisation obtain funding for the project from any other source?*
If Yes, please list all other sources of funding and amounts being provided from each source?
If No, please state your reasons why?
Without the grant, would your organisation be able to carry out the project?*
If yes, please explain your reasons for applying
If no, what is your contingency plan if unsuccessful from the charity?
Does your project or organisation involve working with young children and/or vulnerable adults?*
If yes, please send your safeguarding policy within 24 hours to firstname.lastname@example.org
Does your organisation have adequate insurance in place to enable the project to be carried out in a safe and competent manner (this includes having insurance in place to cover the health and safety of anyone involved in the project)?*
Does your organisation agree to comply with the terms and conditions contained in the Letter of Grant?* (found here)
Will your organisation permit the trustees or representative to visit your organisation or the project for the purpose of monitoring the use of the grant? (please note: this will not be necessary in all cases)*
Does your organisation agree to acknowledge the Charity and the grant in any publicity material relating to the project?*
If required by the Charity, does your organisation agree to submit a report or reports demonstrating what progress has been made on the project? (In certain cases, future instalments of grant payments will only be made upon receipt of a satisfactory progress report)*
For my application to be considered, I understand I must forward a copy of my most recent accounts to email@example.com*
How did you hear about Middlesbrough & Teesside Philanthropic Foundation?
FOR RESEARCH GRANTS ONLY
Is your organisation fully authorised to carry out the research?
Do you confirm that your organisation will comply with all relevant statutory legislation and other regulations in force in so far as they relate to the research?
Has your organisation obtained all of the necessary consents and authorities required to carry out the research?
How do you intend to publish the results of the research you carry out?
I declare that the contents of this Application Form are true.
Please note: We require a copy of your latest accounts and a full breakdown of how the funds will be spent. Please send these in a separate email to firstname.lastname@example.org within 24 hours of applying.
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Middlesbrough and Teesside Philanthropic Foundation