Cobalt Community Fund Application Form

Community Fund Application

Project title:*

0 of 100 max characters

Project start date*

Project end date*

Dates and times the project will run*

Please note: Confirmation from venues is required before application is submitted

Total cost of project:*

0 of 5 max characters

Amount of funding you are requesting:*

0 of 5 max characters

How much match funding have you secured?*

0 of 200 max characters

Please provide details of the amount and funder. Eligible projects must secure at least 20% match funding.

Where is match funding from?*

0 of 200 max characters

Is this project related to youth and play?*

Yes

Do you receive funding from Liverpool City Council's Youth & Play Grant scheme?*

Yes

If you have ticked yes, your application MUST NOT show evidence of double funding. If our Partnerships team suspect double funding, your application will not progress to panel stage.

Which priorities does your project meet?*

Healthy happier fairer

Educated and skilled to succeed

Safe and thriving neighbourhoods

Low carbon and accessible

Strong and inclusive economy

Exciting and inclusive city

Name of organisation:*

0 of 200 max characters

Address:*

0 of 300 max characters

Postcode:*

0 of 7 max characters

Contact number:*

0 of 12 max characters

Email address:

Social media links:

0 of 200 max characters

Name of main contact:*

0 of 100 max characters

Position in organisation:*

0 of 100 max characters

Organisation's objectives and activities:*

0 of 500 max characters

Does your organisation have its own bank account?*

Please note we are unable to allocate funds into individual bank accounts.

Please provide us with details about your project

Overview of your project:*

0 of 1500 max characters

Project aims and evidence of project needs:*

0 of 1500 max characters

How many residents across the Cobalt community will benefit from this project:*

0 of 1500 max characters

Ages of participants who will benefit from the project:*

0-16

16-25

25-50

50+

Neighbourhoods where participants who will benefit from the project live:*

Croxteth

Fazakerley

Norris Green/Sparrow Hall

Please list all costings relating to the project:*

Item

Amount (£)

Please complete your first costing and then click the + icon to add the next amount.

Breakdown of costs that you are applying to be covered by Cobalt’s Community Fund grant:*

Item

Amount (£)

Please complete your first costing and then click the + icon to add the next amount.

Please tell us the plans you have in place to measure your project's long-term impact:*

0 of 2500 max characters

Evidence required to measure sustainability.

Declaration*

I confirm that the information contained within this application is true and accurate

I agree to use Cobalt’s logo on all publicity for the project

I agree to Cobalt publicising their contribution to the project

I agree to any spot checks which Cobalt may perform on the project

Please attach supplier’s quotes for the items you are requesting funding for (.png or .pdf)*

Drop files here or

Accepted file types: *pdf, png, docx, jpeg, jpg, jpg*, *docx, *doc, pdf, Max. file size: 50 MB, Max. files: 10.

To support your application we would like to see quotes/costs for projects wherever possible. Please attach pdf/png/word files to your application using the file upload button. If you have any questions, please email allpartnerships@cobalthousing.org.uk

I have attached any written quotes for the items funding has been requested for:*

Yes

I confirm that my group has the following policies and documents (tick those that you have):*

Constitution or articles

Employer’s Liability Insurance

Risk Assessments for the project

Safeguarding Policy

Public Liability Insurance

Health and Safety Policy

DBS Checks for relevant staff

Please DO NOT send the original documents themselves.

Signature (typed):*

0 of 100 max characters

Date:*