Grant Application Form

Please complete and submit this form for consideration of a grant from Mochdre Community Council. If any answer is not applicable, please answer 'not applicable'.

FULL NAME OF PERSON MAKING THE APPLICATION

Name

Address

Postcode

Phone Number

NAME OF ORGANISATION/BANK DETAILS ON WHOSE BEHALF THE APPLICATION IS MADE. (IF AWARDED, PAYMENT WILL BE MADE TO THIS ACCOUNT)

Name

Address

Postcode

Charity Number (if applicable)

Name & Address of Bank

Bank Account Name

Bank Sort Code

Bank Account Number

Objectives or Purpose of Organsation

Please state precise purpose for which grant is sought, including the estimated cost of any particular project.

Please give full details of any grants or other financial assistance being obtained or applied for from other sources including Conwy County Borough Council and state the amount of any monies raised voluntarily in the locality towards the project.

Does your organisation have a written constitution.

Yes

Please upload a copy of the last audited accounts and latest bank statement.

Please state amount of grant applied for: - N.B. This section MUST be completed

Please state how the grant is to be used or allocated:

Please give any other detailed information that may help with the consideration of this application to include if/how your project/activity will help towards meeting one or more of the National Well-Being Goals (see attached):

Data Protection: The information you provide on this form will be processed on a spreadsheet and shared with members of Mochdre Community Council, strictly for the purposes of considering your application and in accordance with relevant legislation. Please tick the box to give your consent: