Expression of Interest Form

This form should also be used for Grassroots Grants applications.


Name of Group
Contact Name
Address for Correspondence:
Address Line 1
Address Line 2
Town
County
Postcode
Address of Group: (This should be the area your group works in)
Address Line 1
Address Line 2
Town
County
Postcode

Daytime telephone
Evening telephone
Fax
Email

Project Title
Proposed start date
Proposed end date

Annual Turnover:
Average Turnover last three years:
Organisation Start Date:
Is this application for funding for:	New work Continue existing work

If we ask you to send in a application you will need to have the following documents. Please tick below to ensure you have these documents.
Constitution	(Signed by Management Committee)
Child Protection Policy	(Signed by Management Committee)
Vulnerable Persons Policy	(Signed by Management Committee)
Accounts	(Signed by Treasurer)
Bank Account	(This must have two unrelated signatories)
Cash flow Projection (For groups less than 12 months old)	(Signed by Treasurer)

About your project
1. Please provide an explanation of the project you wish to undertake and why:
2. How do you know this project is needed and how will it benefit the local community?
3. How much will the project cost in total?
4. Please give a detailed budget for the proposed project (This should include cost per item including VAT and any funding already confirmed).
5. Funding required from County Durham Foundation.
5. How will you fund any outstanding balance? (If you are applying to other funders please state who and when you expect to hear from them).
6. Why do you think County Durham Foundation should fund this project?
7.How easy did you find this form to fill in?

Please tick to confirm:	I declare that the information in this application is to the best of my knowledge true and correct.
Name
Position
Date

Please note: Once you have submitted this form you will receive email confirmation that we have received your expression of interest. Attached to this email will be a copy of the completed form for your records.