Acorn Community Benefit Fund Section 1 - Organisation Name of your organisation Address of your organisation Address 1 Address 2 City State/Province Zip/Postal Code Country Website http:// Telephone (###) ### #### General/Office Email Main Contact Person * These are the details that will be used for correspondence purposes. First Name Last Name Job title Work/Office Phone (###) ### #### Mobile Phone (###) ### #### Email What type of organisation are you? Select as many as appropriate. If you are a CIC please provide us with a copy of your CIC 34 report. If you are a CIO please ensure that you tick both the 'CIO' and 'Registered Charity' boxes and include your charity number, when prompted. Registered charity Company limited by guarantee Unincorporated club or association Community interest company Charitable Incorporated Organisation Other Income Over Last Accounting Year What are your current unrestricted reserves? Staffing and volunteers How many of each of the following are involved in the organisation? Section 2 - About your organisation and grant application Project / funding start date MM DD YYYY Project / funding end date MM DD YYYY Where is your project taking place and where will your beneficiaries be from in the main? Which local authority will the activity take place in? Please provide a postcode which represents the geographical area you will benefit. Please describe your funding need referring to the Acorn Bioenergy criteria. Please remember to include how, what, why, how elements in your description. Please use no more than 300 words. What needs and disadvantages will your project address and what opportunities will this create? Please use no more than 300 words. What positive changes would this grant make to the lives of people who use your project/service? Please use no more than 200 words. Please explain how you will measure and report on the positive changes made? Please use no more than 200 words. How do you see this project/activity progressing after this funding comes to an end or do you see this as a one off project/activity? Please use no more than 200 words. Please give details of any local networks or partnerships you are involved in? Please use no more than 200 words. Section 3 - Impact Main theme/OutcomesPlease select one of the following core aims that best describes the overall aim of your project. You can select two desired outcomes or aims in this section if you feel you are covering more than one area. This information helps us identify the range of projects supported by the Fund over its lifetime. Select the primary outcome for your project or activity Additional support for training and employment Education and Culture including support for local facilities and organisations Social Assistance to support projects involved with care and health Local Sports, including improvements to facilities and sponsorship for local teams Promotion of Renewable Energy Locally Improvements to local Infrastructure Select the secondary outcome for your project or activity Additional support for training and employment Education and Culture including support for local facilities and organisations Social Assistance to support projects involved with care and health Local Sports, including improvements to facilities and sponsorship for local teams Promotion of Renewable Energy Locally Improvements to local Infrastructure Primary Beneficiary How many people will benefit from this funding? Primary Beneficiary Primary Issue Biodiversity Community spaces Core funding Education Environmental conservation Environmental improvements Fuel poverty Natural spaces Poverty and disadvantage Recreation (leisure activities) Renewable energies Waste reduction Wellbeing Other Issue Section 4 - Project Budget and Consent Project budget What is the total cost of the project? How much has been raised so far? How much money are you applying to us for? Overall Costs - breakdown of your total projectIf you are applying for a building energy audit, please include this cost as an additional line in your budget. Requested amount Total cost Breakdown Supporting DocumentsPlease provide the following documents as part of your application. We require this information as part of our assessment process, so please do ensure we receive them prior to the deadline as we will not be able to progress your application without this information.For all applicants:A signed copy of your latest Annual AccountsA photocopy of one bank statement from the last 3 monthsFor all new applicants:A signed copy of your constitution or set of rules (if you are a CIC please attach your CIC 34 report)If relevant to the nature of your project or activity, Child Protection/Vulnerable Adult protection policy; Health and Safety policy; Environmental policyCopies of written estimates or catalogue pages, if you are applying for a grant to purchase equipmentNames of all management committee members, with cheque signatories identified Documents to follow by email (please email communitybenefit@acornbioenergy.com) Yes DeclarationI am authorised to make an application on behalf of the above group/organisation.I certify that the information contained in the application is correct.If the information in this application changes in any way I will inform Acorn Bioenergy Ltd.I give permission for Acorn Bioenergy Ltd. to record the details of my group/organisation electronically and to contact them by phone, mail or e-mail with information about its activities and funding opportunites.I am happy for the information contained in the application form to be shared with project partners for the purpose of decision making.Terms and conditionsIf your application is successful, you will spend the grant as described in the letter of approval. This sets out the amount of funding, the scope of your project and the intended period in which the project is expected to be completed. It may also set out additional terms and conditions appropriate to the project in question. If your circumstances, or your plans, change significantly please contact Acorn Bioenergy Ltd. to agree the changes to your project before spending any further funds. When you finish your project you will send a monitoring report to Acorn Bioenergy Ltd. If the project is not completed within 12 months of the date of the letter of approval, then you will submit an interim report. If you do not return a report your organisation may not receive further grants from Acorn Bioenergy.You will keep accurate and comprehensive financial records (including audited accounts if applicable to your organisation) to describe all expenditure involving the use of the grant including receipts and invoices. These records must be made available for inspection when requested by Acorn Bioenergy Ltd. or its approved auditors for up to 7 years after the project is completed.If the grant, or any part of it, is made for the purpose of purchasing equipment, you will ensure that insurance is arranged to cover theft and/or accidental damage as appropriate. You will not dispose of any equipment purchased with the grant without the prior written consent of Acorn Bioenergy Ltd., except for equipment which is at the end of its manufactured design life or which is destroyed or rendered unusable.You will acknowledge the source of your funding and Acorn Bioenergy Ltd. in any leaflets or publicity relating to this funding and in your annual report.If you have not used all of the funds at the end of your project, you will contact Acorn Bioenergy Ltd. to ask approval of an alternative use of the funds, or will return the unspent amount to Acorn Bioenergy Ltd.You agree to ensure equal opportunities in employment practices, membership and in the delivery of any services.View our full Terms and Conditions here. Please check to agree you have read and understood the above. * Yes Please check this box to confirm you are happy for us to use your application content in our publicity (if successful) Yes Thank you. We will be in touch shortly.
