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The application form for clubs and societies of NUI Maynooth, provided by Maynooth Students' Union.
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For Academic Year:
2011 / 2012
Clubs & Societies
Grant Application Form
Club / Society Name:
____________________________________________
1
Committee Details
Name
Committee Members
Title Name Student Number E-mail Contact
Numbers
Chair
Secretary
Treasurer
PRO
Equipment Officer
Safety Officer
Honorary President
Name of Club / Society: ____________________________________________________
Club / Society E-mail Address: ____________________________________________________
Website Address: ____________________________________________________
Club / Society Honorary President:____________________________________________________
E-mail Address: ____________________________________________________
Telephone Number(s): ____________________________________________________
Note: The Honorary President of each Club or Society must be a Member of NUIM Staff
2
Affiliation
Please list all organisations the Club / Society is affiliated with.
Governing Body Is Affiliation Compulsory? Affiliation Fee
1
2
3
4
5
Insurance
Are the Club / Society members insured by the Governing Body above? YES / NO
If Yes, please attach details of the cover provided.
If No, please indicate if the Club / Society takes out any insurance cover in addition to
NUIM insurance. YES / NO
(Attach details of the cover provided)
Banking Details
Account Name Account Number
& Sort Code
Balance at date of
application
Signatories
Note: You must have at least two signatories, one of which must be the Club / Society
Treasurer
Please attach a copy of your most current bank statement. Applications that do
not have a statement will not be considered.
3
Membership
Number of paid up members: ____________
Total income from Members: ____________
Note: Please ensure that you submit your membership lists with the grant
application form.
A copy of the bank lodgement of membership fees must be submitted with
the grant application form.
Sponsorship
Please outline below only sponsorship that has been secured for the academic year.
Company Name Value of
Sponsorship
Club / Society’s Obligation to
Sponsors, e.g. name on programme /
jersey, etc
1
2
3
4
5
6
7
Safety Arrangements
Please provide details of any safety policies/procedures the Society currently operates eg.
Safety Statement/Risk Assessment/Emergency Plans/ Equipment Maintenance or Inspect
Schedules etc.
4
Planned expenditure:
All Clubs and Societies are asked to outline their planned expenditure for the coming
year. A breakdown of your planned expenditure is required i.e. cost for transport,
accommodation etc for each event.
Date Details Cost
Any outstanding debt
Total Planned Expenditure: €
5
Planned Income:
All Clubs and Societies are asked to outline their planned income for the year. A
breakdown of your planned income is required i.e. where the money is coming from for
each of your events
Date Details Cost
Currently in bank
Membership from Fairs Day
Total Planned Income: €
6
Case Submission:
This is your chance to tell the Capitation Committee about your Club/Society. You
should outline any achievements in your Club/Society in the previous year and what you
hope to achieve in the coming year.
7
Capital
Assets List
Please list all assets that are valued at €10 or more, which are held by your
Club / Society.
Asset Place of Storage Value Age Insured?
1
2
3
4
5
6
7
8
9
10
Note: If equipment is insured a copy of the policy must be provided.
8
Application for the Purchase of Capital Equipment
List in order of priority.
Equipment Purpose Number
Required
Cost per Unit Total Cost
1
2
3
4
5
6
7
8
9
10
9
Summary
Item Cost
Total Income
Total Expenditure
Difference
Capital
Total Funding Applied For
Chairperson’s Signature: ____________________________________
Treasurer’s Signature: ____________________________________
Date: ____________________________________
Please note: Capitation Applications forms must be handed into the
Students Union office.
Please ensure a recent bank statement and full members list is
attached to your application.
10
Access to Clubs & Society’s Room
In order to be able to access the Clubs & Society’s Office in the Student Centre, you need
to provide us with the following information.
Please note access to the Clubs & Society’s Office is restricted to Committee Members
only.
Name Course Year Student Number Bar Code Number