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..4 London Borough_ of Hounslow
Closing Date: 4 January 2011Community Investment & CohesiCommunity Services R lEe iEI[VI if;:, i!~..
- ~ JAN 2011
COMMUNITY INVESTMENT FUND 2010/2011APPLICATION FORM
LAw ~ S l~ PHf) 13
Lt 11--1 Y £. (C~--1t~e.,e. LCi b~VtWNS\Q.J YQA~ C6'JTt26
l.<\ ~~ S, l6. Y fl-oAO
IAQA~s.\~H\0OLE s,€"><
Postcode:, W 3 \NY
Telephone Number: OlO~ . Fax: Email: p(~Hn!\L9.tl~bl::-°F«'rl~lt{.C v11c; ~L &-~y 2
Name of contact person: 1)e<3ozAvt 6AfZN c'lT
Postcode -r~~ /N'I-Telephone Number: (:) OLO <? Fax:
m;;L~4L-
Amount of grant applied for £' ~ 000
Please specify one criteria category under which application submitted. (Refer to enclosedlist of qualifying criteria).
1. What are the main services of your organisation?
'10, PfOJide. \nt.e~:oh(Y) .por ~Cun.5 pecple ~;tn OVld "
V0\iV\eut dISob,ltbe-S to fWfY) friendShiPS Wrl'Vt 1,1{eMif1C'1ed
pe-cp\ So'thej C0n -thm b.A;\d ccnf7'c/ &'lee to 3~~into~e CO{VyY)l.1()'~ t-0coethc:r cO t-Qke pore jf) CAcho,heS.~e.0 l.-UQ..Ald o·thet"vu·,Se 6e- uf\C\6Ie to -I=c.ke::- (JOlt ;n,
'10 ?r00lde j~/l~~~).e w\~ a.SCtFe MeCh{\~ p\Qcer-to -to- ue- port '" 'dc no Ih e.s {Old ;.f\j frC/vl s:: port.S t-oOrtS ,.. cr-o.ptS .
2. Please give a brief description of the work or project for which you are requestingfunding.
?hClb (u.,f\S:> eu<c-Cj \h\.Msd~ c~e,,;~ J W e. Cl.Af{~t~ "'eve~ ({:>ro X~fV'C,.-te~ bs - -=/0 tv' C'tvIse,rS f(Q"Y'l \ \ (J ecvs upWCrdS.
SOY\ e. lA.)/Iv, P"'~~;Ca;.1 f l e-G(";A~ or SOCred di fflcVllh'es.
L·,-t:lle.. nOlS+e:rS Pevent IIC~d(ef j' ~p )S fw: C/I \h~'$cI~. _Mc>{)"'''/jS F-CY (?c e - S c~,001 el,.,l \ d va dVj OJ cI \...A.), ""eut- c\, SCt6, I,/') esr=cr (7CArE'/'lt c£ C'o.r€.JS eO fV\eet:: 0"" €f.s p-O"v' I~ ~ C~vf'\ ).~
<And FCf ~e;( C0;\dre/) t-o (//OJ il\ Ct Sc;fe.. ef'uirOlfV'enf.. .
'1he. Mc.j01'~ Of OAr JCMf'Jpeeplt:' ad-fend SChc>c>\ or
Co\\e~Se Gnd f10d It- l)e~ diffiCult fCD o.c.ces.~1O-ArS CY'och"u;6e-S, lDC'C\(j (c1Lote,. teD {-vo(\S'por{:-
Or eoen Sel f c"S1-e-&v1 _ Ih~ f;"d ,'t- d iff-" (vt It-
hP I'f\t-erc.ct LA)I~ c\>'er 'jCA'j pecple. GAt- lr,lje
Lue.- rrcu,'d e. ~L SuppO/c ~ e~ 1\<' e cl t-o clo f'h )'s.
4. Please give a breakdown of the main tasks involved in the setting up/running of yourproject:
----r0;s, IS 0 Ccnhf\Uif1j p{oJec~ uJ~e(e werr~)'d e \ yevth Club I ~ pe LAC'ho ~h·e--S. F--CYJo...n~ p-e-qJ(C lc-o f'v\ e eJ:: c(\d t-ckC'- part If).
'Fer ex- OMp ,-c:/ c",c- V)O,h ~ (u.n ec...c ~ s:- e. S~ )'Cr) IIK.e
\.=xn.s k.e..t-\.:::,~I\ /' f-oo't \:::::>C{ \ \ J (? 00\ CCJv)(7e h'G'en I
vr-tS rr Cro.-f\cS So ~e j~ pe.rscn COli t-ctke
3<::fV'1eth;~ her\-) e. we LA.\So occcS'~1'01C11-J h.CDe\ Cv.-t-Slde I <j-(CupS CCi>\ e. \f\ t: 0 'VI!) W Ork'S hopS
'(l j)rD.rv-\c. MuS \C cY Dcn c-c../
5. How do you intend to continue to fund the project after the Council's grantends?
+l;Y)c\rOl \~ ~(\.3 6~ \ (\()0\\.)\ (\-5 OA r ~~(\ J (J..e op Ie
TV'\ spcnscyed euent~ end ~~res.
If YES, please give charity registration number:If NO, please give status of your organisation
Are you affiliated to any other national, regional or localvoluntary organisation?
If YES, please say which:P~ob lA '-< / ~10J{\SJ~ yO.A h, S -era ,ce
Does your organisation have a Management or Executive committee§NO
yes
ChairpersonVice ChairpersonTreasurerSecretary
-- HOlik BlOtLL< vJ-e iI (S(r~C,;{p-eJSC0 endT f€CtSure,. ,t hex.sS-een CC/\f1! Me cI ~.\\--.c: C.her; h~e ~Co(V'(Y1 iSs: \QI ~ Ctt
b ~e ccn ~Q\d \:?o~
Please list skills and experience necessary to carry out these posts.PDS 1\J'm-S .A\l St-~ff hc>\.J-e.. CCM(Jlet ed Or tA1cf{'i~ki~ re le,ucnt
W\JQ'$ .'firS\- A',d 1Y0I;(\ 'If' 5 HmuCtIlA.Old lin~ hrC1;();(\~ / Se )(UCI. I b1eCtI~\ fc-;f\:(\J - L<tss' I nrdC\$ tC> etr;Je- M\{\~~S I ~q,uCt I cp~Ivt(l"Jies\{C\;1\;f\5 I 'r:tvcdLACh-O"\ to YCvt~, l}jo~k / G\l StO.PE- Ore.
(e~V1\ved t-o ~Cl.l.<e{701t- I () COIhf1U;':5 {YrU'/f'I\f\-S f<YcleuelCfeMeniHow many volunteers are regularly involved in the work:of your organisation?
\-I\Orl< B\OtCl<~\1Jd,n S t-e.(.? ~enSHo.rV( ~ IC1CL-cv0e.-\ \
'De6\o'i e. barl'e.CcHow many paid staff does your organisation employ?
10 + ~ 2. Cvilel'ytl.j lX\cle(tC\~;~'l ~e_,'r N\JQ
1(\ ~ea\~ f. Socla\ (Ore.. end dc\(\~ ~e. ll\rvoduCh'Q1
~o '1OJ.t'h WO/L( CC\prSe... \J o\l.nt-e-ers, w"'-o Ore
C'\o\~ 'VLAI<.e- Of- Ed;n l:>LAr8~ I LA.)Ovl.( ~ >cpeJ1fflce or o..-S.
POlt 0 F +Yo; ('; f'lj .
18'0
2. What age groups are the beneficiaries and how will you involve them in thedevelopment of the project?
II - '2 ~ ~ .ecrS
unc1-er r; 'dv3 w',1\J ~el\r
VGr ellt-.S cr co (e...r S
Do you undertake your activities anywhere else other than the above ~~address? YE~
If YES, please indicate where?
&~t: ~T2YLf cn-±:-"'{\~
Have you received any previous grant from the London Borough ~of Hounslow? ~/NO
If YES, please state amount, year of most recent grant and thedepartment received from:CQrpcra~e (Z-e-uenve- CICt't- t S/000
Are you currently receiving a grant from another London Borough ~I
of Hounslow department? ~NO
If YES, please give details:Ai(V\\I1J \A\5~ j{O"f fQ t,Z-:;, DOO encLn5 3lS, riorC/n 201) per-
S Sepo/Ote. (?Icjec*=.s (SOS/AoS1
3G~lArd~ CrCCu0S)3. Are you currently receiving a grant from any other organisation? YES,@
If YES, please state name of organisation, amount and purpose ofgrant:
YES@
If YES, please state name of organisation, amount and purpose ofgrant applied for:
YEs(@)
YEs(§>
@NOYES@
£
Estimated Expenditure £ Estimated Income £
1 Staffing costs -~ 7/1 2o)1t1.1~' 1 Fees/subscriptions/other Lt4\~iXs tCt.fF- chargesGross salariesEmployers N.!.Superannuation
Subtotal t20, 4-,::};i4
2 Trusts/Companies2 Premises costs
a) Rentb) National non-domestic ratec) Repairs and redecorationd) Furniture and fittings "-.I/Ae) Other (please specify)
Subtotal3 Donations/Sponsorship (give
details) C3 Running costs S1ig,w /;1eCft6ec.r l,,{jke S:~~cYed) ?:>aO.DO
a) Telephone ~A .- ,. LovY dd WCdk 266DCJI VCJ\CI.<.E'f\ 'I e 1"'6 t-O'Ib) Printing and stationery] 434.00 (JA ,=cr-e.s US3..00c) Postage 4 Income from other sources,
not included above (givedetails)
d) Insurance - ~I( \ (\ St.-.rOl ce 30Q.(X) (l.A.e) Gas, Electricity, Heatingf) Other expenses
e.g. creche, transport,training
Subtotal r?>bl.oo
4 Cost of other activities(Please show total estimated 5 Cash balancescost of other activities with abreakdown of costs for eachActivity
Subtotal
5 Any other expenses (Please 6 Total grant requested fromgive full details) London Borough of Hounslow {Sp:r;.oo
(A) Total Estimated 1..\ ':1~g.14 (B) Total Estimated Income 'lei b::f· rxExpenditurePlease note: (A) should equal
B) <0cl.L (h~ ~ ""'''' fL~~ ~!t= ~
1. Please indicate the extent of involvement of the community in the activities ofyour organisation as follows (give approximate number where possible)
Women Minority People with Older Young *OtherEthnic disabilities people people appfCxj-
User rou 0 ~ 140 5 t~o Mete.MembershiManagement Z- ScommitteeEm 10 ed staff I
*e.g. gay men and lesbians, ex-offenders, or any other sections of the communitythat your organisation targets.
Post titleLe-odeJyeu \\A w C¥t< erS
- Y()...A~ v00!k hOJ(s ucr.:jd ep60d; "j (Y) woJl<ef
VlCf'l~f~'f'Qvl -:; - 2S; h.ev, S
If part-time, please indicate the number of hours worked per week
PT/FTPTp,
Current salary NI + other costs-k I C; (7-'21~r
£ C) pe.r hr
Fundingauthority
Does your organisations have a written statement andlor a code ~}of practice regarding equal opportunities/diversity? ~NO
If YES, please attachwe- Fo\\Cv0 MG.A\SlO-J YCcA~ Sc:r0 iC-e3, po\iC~
This form should be signed by the chairperson, secretary or treasurer ofyour organisation
Signature ~001 Please also print name '1), 6Af2t--JEi r
Please return this form to:Corporate Community Investment & Cohesion UnitCommunity ServicesLondon Borough of HounslowCivic Centre, Lampton RoadMiddlesex, TW3 4DN