Small Grants Application Churchill Foundation Small Grant Application Form Please read the Small Grants Programme Guide before completing this form Section 1: About This Application Who is completing this form? (tick one) * Churchill Colleague / Owner / Business Partner (Referrer) Individual Applicant Charity / Community Organisation Applicant Note: Either party may complete the form, but a Churchill referrer must always be named and provide context. Section 2: Churchill Referrer Details Name: * Role (Colleague / Owner / Business Partner): * Company / Lodge / Relationship to Churchill: * Email Address: * Telephone Number: * How do you know the individual or cause you are referring? (Please briefly explain, to a level you feel comfortable sharing, the connection and why this request matters.) * Section 3: Applicant Details If applying as an individual: Full Name: * Address (postcode required): * Email Address: * Telephone Number: * If applying on behalf of a charity or community organisation: Organisation Name: * Registered Address: * Contact Name: * Role / Job Title: * Email Address: * Telephone Number: * Charity Registration Number (if applicable): Website / Social Media (if applicable): Section 4: Eligibility Check Please confirm that your application meets the following criteria (tick all that apply): * The request has a named Churchill referrer The project aligns with at least one of the Foundation’s charitable aims The request demonstrates clear personal or community need The project is based in an area where Churchill Living Group operates The request is not for: sponsorship of clubs or events sports teams or clubs schools religious organisations animal or horticulture charities London, Scotland, Ireland, or international projects political, campaigning, or commercial activity completed projects or statutory funding replacement Section 5: Charitable Aims Alignment Which of the Foundation’s aims does this application support? (tick all that apply): * Promotion of health among older people Relief of sickness, disease, and human suffering Support and wellbeing of younger generations Please briefly explain how your request aligns with the selected aim(s): * Section 6: Description of Need a) Who will be the principle beneficiaries of this grant and how will you identify them? * b) What activities and methods will you use to achieve your objectives? How would the Churchill Foundation grant be used to support this? (500 characters max) * c) When will the project/activities start and be completed? (250 characters max) * d) What outcomes do you intend from this project? What would success at the end of this project look like? (500 characters max) * e) Describe how this project/related activities will be managed to enforce effectiveness. (250 characters max) * f) Please share any other information you would like taken into consideration. * Section 7: Breakdown of Funds a) How much grant funding are you applying for from the Churchill Foundation? * b) How much additional funding do you need to secure, in addition to what is being requested of the Churchill Foundation? * Total Funding * c) Is the project/activities dependent on securing the additional funding to progress? * Yes No d) How is any difference (in funding required) being secured?: * e) Is this an existing project, expansion of a new project or a new project?: * f) Please provide a breakdown of expenditure to explain what the Churchill Foundation grant funding will pay for: Item/Expense -(Item 1) * Description -(Item 1) * Cost per item (£) -(Item 1) * Quantity -(Item 1) * Total (£) -(Item 1) * Item/Expense -(Item 2) Description -(Item 2) Cost per item (£) -(Item 2) Quantity -(Item 2) Total (£) -(Item 2) Item/Expense -(Item 3) Description -(Item 3) Cost per item (£) -(Item 3) Quantity -(Item 3) Total (£) -(Item 3) Item/Expense -(Item 4) Description -(Item 4) Cost per item (£) -(Item 4) Quantity -(Item 4) Total (£) -(Item 4) Item/Expense -(Item 5) Description -(Item 5) Cost per item (£) -(Item 5) Quantity -(Item 5) Total (£) -(Item 5) TOTAL £ * Why these costs are needed: Please use this space to further explain any costs (such as why it is necessary and how it helps): * Section 8: Supporting Information Please list or attach any supporting documents you would like us to also consider, eg. quotes, project specifications: Drop a file here or click to upload Choose File Maximum file size: 2.1MB Section 9: Declaration I confirm that the information provided in this application is accurate and complete to the best of my knowledge. Name: * Role (Applicant / Referrer): * Date * Signature * signature keyboard Clear Submitting Your Application You will receive an acknowledgement via email once your application has been received.Applications are reviewed at scheduled trustee meetings (approximately quarterly).Incomplete applications may be deferred to the next cycle. Submit If you are human, leave this field blank.
