Grant Funding Application Form

Prevention and Communities Grants Programme

(To be completed by the Applicant)

We are committed to being accessible and inclusive. If you experience or anticipate any barriers within the application process or require help to make an application or accessing services and information, please contact us. Alternative formats of all our documents can also be made available on request, including larger print, other languages, Braille and audio versions.

Birmingham City Council (the Council) has a responsibility to ensure that any public funding it provides is used for its approved purposes and that when a group or organisation receives funding it is used appropriately. The questions in this application form reflect this and include reference to the operation of suitable management, employment and financial policies and practices.

Please ensure you read and understand the accompanying Application Guidance whilst completing this form as it provides useful information about the application process and form, including eligibility and restrictions. For any queries please contact PreventionandCommunities@birmingham.gov.uk

Citizens lead healthy, happy, independent

lives within their own homes and

communities

Social Care & HealthReduced demand on statutory services

Financial savingsAdditional investment from outside BCC and

the NHSA better experience for the social care and

health workforce

CitizensIncreased social

participationHealthier lifestylesMaximised income

Housing which supports

independencceCarers feeling more

supportedBetter experience of the social care and

health system

Communities Relevant, diverse

and accessible community assets

and activitiesRelevant, diverse

and accessible opportunities for

active citizens and volunteering

Behaviours and cultureBetter cross-sector partnership working between the statutory,

voluntary, community and social enterprise sectorsEmbedding of a culture which focuses on and support the

strengths, assets and positive outcomes for citizens

Overview of this application form

Section No.

Section Title

1. Overview and contacts

2. Your proposal

3. Outcomes, value, impact and benefits

4. Delivery details

5. Your organisation or group

6. Policies, Procedures and Processes

7. Declaration

Please submit your completed proposals and accompanying documents or files to PreventionandCommunities@birmingham.gov.uk.

All proposals for “Community Opportunities” and “Prevention & Early Intervention” grants must be received by 12pm on Friday 28th June.

All proposals for “Community Inclusion” and “New & Emerging” grants must be received by 12pm on Friday 26th July.

1. Overview and contacts

Name of your project/activity/service/proposalAmount of funding you are applying forProposed duration of the project/activity/service, including start and end dates

Which programme are you applying into for this application? (please tick)Community Opportunities – restricted to organisations and groups currently funded through the Third Sector Grants programmeCommunity Inclusion – restricted to organisations and groups with an annual revenue of less than £100,000 per annum (for revenue) and organisations with an annual revenue of less than £500,000 per annum (for capital)Prevention and Early Intervention - restricted to organisations and groups currently funded through the Third Sector Grants programmeNew and emerging relationships with Adult Social Care – organisations and groups currently funded through the Third Sector Grants programme are excluded from this programme

Main contact Alternative contactContacts for this applicationOrganisation or groupPosition heldPhone numberEmail address

Name of organisation or group applying for funding or lead organisation or group if applying as a partnershipRegistered addressMain phone numberWebsite, blog or Facebook page, if you have oneType of organisation (please tick the box which describes your organisation and where applicable provide your registration number)

Unincorporated Association with a constitution, committee and regular meetingsLimited companyRegistration number:CharityRegistration number:State type of organisation CIO, CIC, Partnership etc.Registration number:

Partner organisations (list all that apply and leave blank if there are no named partners)

2. Investing in your Proposal/Project/Activity/Service

Have you discussed your proposal with a representative of either Adult Social Care Commissioning of BVSC? Please provide details

Who are the main beneficiaries of your proposal? (please tick all that apply)

Projected number of beneficiaries

Total

With an assessed care

need (Community

Opportunities Grants only)

Older peoplePeople with learning disabilitiesPeople with physical disabilitiesPeople with mental health conditionsOther potentially vulnerable adults (please comment below)

Which programme priorities and themes are relevant to your proposal? (please tick all that apply)Advice and support (including peer support)Affordable warmth and fuel povertyArts and cultureBereavement, death and personal lossCapital (including adaptations and improvements of buildings and/or equipment which can support community inclusion)Community and day opportunities (excluded from “Prevention and Communities”)Digital inclusionEmployment, volunteering and skillsHousing and hoardingPartnershipsSport and physical activityTransport and mobilityOther – please specify below:

Please name locations which your activity or service will be delivered to or from (please refer to https://www.birmingham.gov.uk/info/20057/about_birmingham/665/wards_and_constituencies for details about Constituencies and Wards)ConstituenciesWardsNeighbourhoods (free text)

Please provide an outline and summary of your proposal and why you are applying for funding (maximum limit of one side of A4 in Arial 11). In your answer please provide details of any important outputs/deliverables, the number of beneficiaries, where activities or services will be delivered, the problem, gap or opportunity you are responding to.

This answer can also be provided by video or as a short set of slides – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

Tell us about any progress you have made to date in developing or delivering this project/activity/service, prior to this proposal (maximum limit of one half side of A4 in Arial 11)

This answer can also be provided by video or as a short set of slides - This answer can also be provided by video or as a short set of slides – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

How have the potential beneficiaries for your proposal been engaged and involved in its design and development? (maximum limit of one half side of A4 in Arial 11)

This answer can also be provided by video or as a short set of slides - This answer can also be provided by video or as a short set of slides – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

If your proposal involves the delivery of activities and services to adults with assessed care needs, what involvement has there been from Adult Social Care representatives in the design, development and delivery (before this proposal) of your proposed activity/service/project? (maximum limit of one half side of A4 in Arial 11)

This answer can also be provided by video or as a short set of slides – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

3. Investing in outcomes, value, impact and benefits

Which prevention first outcomes will your project achieve? (please tick all, which you will be able to evidence and measure)

Citizens

Increased social participation

Healthier lifestyles

Maximised income

Able to live independently in their own homes

Carers feel more supported (as people and as carers)

Communities

Citizens are able to access a relevant and diverse community offer

Citizens are able to access opportunities to actively participate in their neighbourhoods and community/communities

Behaviours and Culture

Better internal partnership working across the Council and NHS

Better cross-sector partnership working between the statutory, voluntary, community and social enterprise sectors

Embedding of a culture which focuses on and supports the strengths, assets and positive outcomes for citizens

Social Care & Health System

Reduced demand on social care and health services

Financial savings

Happier, more productive workforce

Additional investment in the social care and health system

For each of the boxes you ticked above, please answer and outline the following as appropriate:Citizens – please consider and refer to the following (maximum limit of one side of A4 in Arial 11):• How would you increase people’s social participation? What evidence can or would you provide to show

this?• How would you help people adopt healthier lifestyles? What evidence can or would you provide to show

that people would be adopting healthier lifestyles?• How would you increase people’s income? What evidence can or would you provide to show this?• How would you help people to live independently and stay in their own home? What evidence can or

would you provide to show that people are continuing to live as independently as possible in their own homes?

• How would you help carers to feel more supported? What evidence can or would you provide to show that they feel more supported?

• How would you improve the quality of life of citizens? What evidence can or would you provide to show this?

This answer can also be provided by video or a photo album – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

Communities – please consider and refer to the following (maximum limit of one side of A4 in Arial 11):• Who is the community which would benefit from your proposal?• How would this proposal add to the offer already available for that community?• What are you doing to ensure your offer is both accessible and will remain relevant to your community?

What evidence can or would you provide to show this?• What would you do to create opportunities for citizens in your community to be more involved, e.g. in

decision making, forming groups, volunteering?

This answer can also be provided by video or a photo album – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

Behaviours and Culture – please consider and refer to the following (maximum limit of one side of A4 in Arial 11):• What strengths, assets, aspirations and needs have you identified within your community, beyond the

scope of what your organisation, group and proposal might support?• How are you working with other organisations and groups to best support those strengths, assets,

aspirations and needs?

This answer can also be provided by video or a photo album – please refer to the application guidance. If you do provide an alternative submission you may use the section below to provide a brief summary which should be no more than a single paragraph.

Social Care & Health System – please consider and refer to the following (maximum limit of one side of A4 in Arial 11):• How are you reducing demand on statutory services such as social care? What evidence can you provide

to show this?• How are you generating potential savings to statutory services, such as social care? What evidence can

you provide to show this?• What additional investment (such as external funding and volunteer time) are you bringing to the activity

or service? How is this bringing additional investment into social care and health?• How are you improving the experience of social workers and people working in the NHS? What evidence

can you provide to show this?

Mandatory question for proposals seeking BCC investment of £200,000 or more (over the two years) and/or organisations with an annual income exceeding £1million per annum. (maximum limit of one half side of A4 in Arial 11).

What skills, expertise, knowledge and additional value would you be prepared to share and invest in groups and organisations awarded funding through this programme?

4. Delivery details

To be completed for “Community Opportunities” grants onlyIf your proposal is centre-based do you currently have WiFi available to people attending or who would attend the centre?If not, are you intending to provide WiFi from the centre(s)? Please provide relevant details

All proposals - MilestonesPlease tell us about the key events in the life of the project/activity/service e.g. the start and end dates, when events will take place, when progress will be measured or the activity evaluatedProject / Activity and brief description Date

Insert more rows as required.

All proposals - RisksPlease use the table below to identify any risks that could prevent your project / activity from being delivered as planned. - Please note this is not a health and safety risk assessment, but is a plan to manage risks to your project / activity, for example weather, lack of funds etc. with Birmingham City CouncilRisk description Probability (high,

medium, low)Impact (severe, moderate, light)

Actions taken to manage risk

Insert more rows as required.

All proposals - Funding, costs and expenditurePlease detail all costs and expenditure involved in the delivery of this proposal. This will need to include one line per item and:

Details of each item of expenditure and what it will be spent on including details of any organisations / individuals you will pay to undertake any provision of the activity.

An explanation for any assumptions e.g. project manager (5 days @ £x per day); A5 flyers (2,000) etc.

If your budget includes unexplained costings then you may be asked to resubmit your budget as part of the assessment process.

Cost of activities - Project/activity expenditure, e.g. Items, paid individuals, expenses

Recipient (please allocate partner

organisation or group)

Expenditure

How much of the expenditure are you requesting

from BCC through this application?

Contributions - Project/activity income/in-kind support - Provide details of any other income or in-kind contributions towards the project/service/activity e.g.: own cash; grant funding, sponsorship, donations, volunteers (please apply the Birmingham Living Wage to provide a financial value)

Do not include the amount you are applying for through this application.

Contributor (please allocate

partner organisation or

group)

Contribution

Example: A B Sponsorship £1,000Example: Sports equipment £3,000

£££££££

Insert more rows as required. £Total: £

If yours is a partnership proposal, please summarise the expenditure and contributions for each partner:Organisation/group Total costs Total

contribution - income and in-kind support

Total funding requested from BCC

£ £ ££ £ ££ £ £

Insert more rows as required.

£ £ £

5. Investing in your organisation or group

Funding and financesWhat was your organisation or group’s income during the last financial year? £

And expenditure? £

Reserves - If you have any reserves please provide a breakdown.Restricted or committed reserves – reserves in your account which are set aside for a specific purpose, such as grants to run a particular project.

£

Designated reserves – reserves that your organisation has allocated to a particular cost, such as staff salaries or rent

£

Free or unrestricted reserves – reserves which are not committed or restricted

£

If you have unrestricted/free or designated reserves that are more than the amount you are requesting through this application, please provide an explanation as to why your activity cannot be supported from these reserves or a copy of your Reserves Policy if you

have one.

Governance and Organisational DevelopmentName of trustee(s)/ Directors, their role, skills/knowledge/expertise they bring to your organisation (Insert additional rows if necessary)1)

2)

3)

4) Insert more rows as required.

Does your organisation have, or is it working towards, a recognised quality standard for third sector organisations e.g. Quality Performance Mark (QPM)?

Yes / No

Does your organisation regularly review its objectives, performance, impact and outcomes? If yes, please provide details Yes / No

If your organisation is from the voluntary, community or social enterprise sectors please complete and submit the VCSE Strength Checker http://vcsestrengthchecker.org.uk report as part of your bid. This does not need to be completed for organisations or groups applying for a “Community Inclusion Grant” or for organisations with an annual income of more than £1million per annum.

The VCSE Strength Checker will ask you a range of questions about your organisation and your organisation’s strengths, and areas to develop to build core effectiveness.  These will be reported under the following headings:

Sustainability Marketing and opportunities Strategy and planning Track record and capability Quality and impact

The information submitted will help us assess what additional support the Council and/or its partners might be able to provide, in addition to any grant awards – across all recipients. This is for the purposes of supporting the development of your organisation and others, the legacy of the project and overall programme, as well as helping you and others to achieve the best possible outcomes and impact from your proposal.

For all proposals which will be working directly with “Adults at Risk” Is your organisation or group a member of the Birmingham Safeguarding Adults Board network? If so, please provide details of your organisation’s involvement and engagement with the network. If not, it will be a condition of your grant to join the network.

When was your organisation’s or group’s safeguarding policy and procedure last reviewed and updated by your board, committee or leadership team?

Who in your organisation at senior level is responsible for the Safeguarding policy’s implementation and monitoring?Name Role within

organisation

Do all relevant members of staff and volunteers have an up to date Criminal Records Bureau check (DBS)? Yes / No

If ‘No’, please state the reasons for thisDo you have in place a record of DBS checks carried out for all staff/volunteers/committee or board members, confirming that DBS checks are satisfactory?

Yes / No

Referees and experiencePlease give details of two people who can comment on your track record, which is relevant to this proposal, the activity or services for which funding is being requested

Referee 1 Referee 2Full NameOrganisationJob titlePhoneEmail addressProvide a brief summary of relevant experience which the referee can comment on

6. Policies, Procedures and Processes

If your proposal is successful and you are awarded a grant, you will need to sign a Conditions of Grant Aid (COGA) document, in which you will agree to meet the conditions summarised below.

You will also be required to submit documents, listed below, before a grant can be agreed and awarded to your organisation.

If you feel you will need any support from the team in meeting these conditions, please get in touch with BCC before applying.

By accepting a grant from the Council, you will be agreeing to the following: Living Wage - You agree to pay the living wage. Please ensure this rate is reflected in

your budget. https://www.birmingham.gov.uk/downloads/file/2530/birmingham_city_councils_living_wage_policy

Insurance - You will have suitable insurances in place for your organisation and the commissioned project. You agree to show insurance documents to us if we ask for them e.g. public liability insurance.

Financial regulations and procedures - You agree to put in place effective financial systems so project costs can be monitored

Counter Fraud and Anti-corruption and Gifts and Hospitalityo You agree to put in place policies and procedures to prevent fraud, corruption or

bribery in relation to your organisation and this grant (including procedures for accepting Gifts and Hospitality)

o You agree to tell us if you suspect any fraud or financial irregularity in the use of this grant

o You agree that the Council can investigate your organisation if we believe there has been financial irregularity, misuse or misappropriation of the grant.

Complaints - You agree to have a complaints procedure in place, including a record of complaints and any action taken.

Safeguarding - We consider that ALL grant funded organisations have the potential to come into contact with children, young people or adults at risk, so we ask for these policies and procedures regardless of the target participants of your project.

o You agree to have safeguarding policies and procedures in place which are in line with Birmingham Local Safeguarding Children Board www.lscbbirmingham.org.uk and the Birmingham Safeguarding Adults Board www.bsab.org

o You agree to provide copies of your Safeguarding policies and procedures to the Council

Why are we asking for these documents? – Birmingham City Council has a responsibility to ensure that public funding is used for its approved purposes and that, when an organisation receives funding, it is used appropriately and provides value for money. This includes the operation of suitable management, equalities, safety, safeguarding and financial policies and practices.

The documents we ask you to submit will help to show us that: Your organisation is well-governed and managed effectively Your organisation is financially viable, so that money we give you is not at risk Members of the public, particularly children and adults at risk, are safe The individuals involved in the project have a strong history of delivering similar projects.

Document Title Send if Requested

Annual Report Constitution or governing body documentation Equalities Policy Health and Safety Policy Safeguarding Policy and Procedures Whistle Blowing Policy

Confirmation of a valid insurance cover for director negligence or breach of duty to your organisation and details of insurance held, particularly relating to negligence

Copy of the template used to record and monitor information relating to DBS checks

Proposal on how the project will be funded once grant funding has ceased

Business Plan for the proposed of acquisition of any premises

Budgeted income and expenditure statement Statement of Reserves Annual accounts and balance sheet Quality Assurance System documentation

Document Title Send if Requested

Complaints Policy Environmental Policy and Procedures Counter Fraud and Anti-corruption policy Gifts and Hospitality policy Financial regulations and procedures

Proof of bank account for your organisation (not a personal account)

CVs for the project leads

Please note: You must be able to provide these documents to the Council on request. If it is later found that you have not abided by the conditions of any grant you have been awarded, your grant may be suspended and you may be required to repay to the Council any grant money awarded.

7. Declaration (All applicants)

I confirm that: The information and supporting documents with this application are correct and

complete. If the requested grant is approved, any additional supporting documents required will be provided.

Details of all other funding related to this activity, confirmed or applied for, have been disclosed.

The required supporting documents are enclosed with this application I am authorised to sign and submit this application for grant funding on behalf of the

organisation.

Birmingham City Council is committed to being open and transparent about decisions which affect Birmingham Citizens. Details of grant payments to voluntary and community sector organisations are published on the Council’s website every three months. To view published information, please go to www.birmingham.gov.uk/vcsf By submitting this application, you are agreeing that your details will be published.

In addition, if you are successful in your application, you may be required to confirm that you have the following in place (depending on the nature of your proposal):

Insurance Financial regulations and procedures Counter Fraud and Anti-corruption and Gifts and Hospitality policies Complaints policy Environmental policy No Platform policy

“General Data Protection Regulation” (“GDPR”), CONFIDENTIALITY STATEMENTBirmingham City Council collects information for the purposes of procurement and payment functions.  The information we collect about you will depend on the nature of your business with us but may be used for any of the Council's purposes.

We may check information provided by you, or information about you provided by a third party, with other information held by us.  We may also get information about you from certain third parties, or give information to them, to check the accuracy of information; to prevent or detect crime; or to protect public funds in other ways, as permitted by law.  These third parties include other local authorities, government departments, credit reference agencies and the police.

We will not disclose information about you to anyone outside the City Council unless the law permits us to.

Confidential information will not be disclosed to third parties.  We recognise that information is valuable and we take all reasonable measures to protect it whilst in our care.

The City Council is the Data Controller for the purposes of General Data Protection Regulation.  If you want to know more about what information we have about you, or the way we use your information, you can ask at our main offices or telephone the Corporate Information Governance Team on Tel: (0121) 303 4876.

This section must be signed by the person who completed this form, on behalf of the organisation applying. The witness must not be a relative of the person who completed the form.

Form completed by: Witnessed by:NameJob titleSignatureDateOn behalf of (organisation name)

Please submit your completed proposal and accompanying documents or files to PreventionandCommunities@birmingham.gov.uk

All proposals for “Community Opportunities” and “Prevention & Early Intervention” grants must be received by 12pm on Friday 28th June.

All proposals for “Community Inclusion” and “New & Emerging” grants must be received by 12pm on Friday 26th July.