Funding Enquiry Form

Please Note:

If you or your group require funding advice and information and are based in Amber Valley please complete this form and we will send a report of potential funders as soon as we can.

Group/Church/Business name:

Contact Name

Address

If the property is in the Amber Valley area please enter your postcode or the first few letters of your street and click on the next button to lookup your property.
Otherwise enter your full address in the box below.

Tel:

Fax:

Email

Where did you hear about the funding service?

Website

Event

Newspaper

Mail Shot

Newsletter

Contacted us before

Does the group have the following?

Constitution (Not required for a church)

Bank Account

Management Committee (Not required for a church)

Project Details

Project Description

Where will the project be based?

Total Project cost

Have you got any other funding?

How much funding is needed?

Capital/Revenue

Who will be applying for the funding?

Have you received a grant before? If so, when, who from and how much?

Any other information

How many years funding is required

If the project involves a building

Does the group own the building?

Yes

No

If not, how long is the lease? (Funders require a long lease before they will invest grant funding in a building)

We have a legal duty to promote equality in relation to race, disability and gender. We are also required by law to assess the impact of any Council policies on the different equality groups in order to eliminate or reduce any adverse impacts on these groups. The following questions are to help us to ensure that we are not discriminating against anyemployees on the grounds of gender, race, disability, age, sexual orientation or religion/belief. The answers to these questions (statistics) will therefore help us to focus and prioritise any necessary equality work in the correct areas. The answers to the survey and the 'About You' section are anonymous and it is not possible to identify individuals from them

Are You?

Male

Female

Describe yourself:

British

Irish

Other

Any other white background:

White and Black Caribbean

White and Black African

White and Asian

Other mixed

Any other mixed background

Caribbean

African

Other

Any other black background?

Indian

Pakistani

Bangladeshi

Other

Any other Asian background?

Chinese

Other

Any other ethnic background?

Please specifiy your age group:

16 to 17

18 to 24

25 to 34

35 to 44

45 to 54

55 to 59

60 to 64

65 to 74

75 and over

What is your religion?

Christian - including Church of England, Catholic, Protestant

Buddhist

Hindu

Jewish

Muslim

Sikh

Other

None

Other Religion?

Do yo consider yourself to be:

Heterosexual

Gay or Lesbian

Bisexual

Other

Prefer not to say

Other please specify:

Do you consider yourself to have a disability?

No

Yes, affecting mobility

Yes affecting hearing

Yes, affecting hearing

Yes, a learning disability

Other

Please specify if other: