PAG First Time Access Fund Application Form Before completing this form please ensure you have read the funding guidance notes and criteria. You may wish to discuss the outline of your project with a member of staff from Barnet Homes for some initial feedback before submitting your application. Question Title About your group Name of your Group: Main contact: Position in group: Address: Postal code: Email address of main contact: Main telephone number: Borough ward: Question Title About your projectProject Title: Give your project a short title so it can be easily identified (Max 10 words) Question Title Project Summary: Please describe your project and what it seeks to achieve (include the aims of the project and where it will take place) (No more than 150 words): Question Title Which priority does this project address & how does it meet the funding criteria? Question Title What is the focus of your project? (Please tick all that may apply). Culture and recreation (e.g. art, sport, music, history) The environment (e.g. green initiatives, clean-ups, green spaces, wildlife) Community facilities (e.g. building maintenance, playgrounds) Community cohesion and engagement (community event) Social activities (e.g. fun days, bingo, lunch clubs) Health & wellbeing including personal and social development Unemployment Financial hardship Training and education Community safety (e.g. crime, anti social behaviour, safety initiatives) Other (please specify) Question Title The local communityWho are the main beneficiaries? (Please tick all that apply). Children, parents and families Young people Older people Minority ethic groups Low income groups People with disabilities or learning difficulties The whole community Other (please specify) Question Title How many people will be involved in organising and running the project? Question Title What is the start date for the project and when will it be completed by? Start date: End date Question Title Project BudgetBreakdown by cost activity: Total project budget (£) How much are you applying for? (£) maximum £750 Question Title Breakdown by cost activity: Item 1 Item 1 cost (£) Item 2 Item 2 cost (£) Item 3 Item 3 cost (£) Item 4 Item 4 cost (£) Item 5 Item 5 cost (£) Item 6 Item 6 cost (£) Other items Other items cost (£) Total (£) Question Title Payment of Grant – Bank DetailsIf your application is successful the grant will only be paid into a constituted groups account. If you are applying as a non-constituted group alternative arrangements will be made on an individual basis on how the grant payment will be made.Are you a constituted group with its own bank account? Yes No (Alternative payment arrangements to be made) Question Title Undertaking We (the named signatories below) declare that the information given in this grant application and accompanying documents are accurate and understand that the information provided will be stored electronically and will be subject to the provisions of the Data Protection Action 1998. By signing this privacy statement I give Barnet Homes permission to use my information in accordance with this privacy statement, The full Barnet Homes privacy policy can be found at www.barnethomes.org/privacy-policy Date: DD/MM/YYYY Question Title Details of First signatory (lead person) Name: Position in organisation: Email Address: Phone Number: Question Title Details of second signatory (another member of group) Name: Position in organisation: Email Address: Phone Number: To request a copy of your completed application form please email getinvolved@barnethomes.org Question Title For office use only Date application received Date application checked Date reviewed by panel Question Title Application successful Yes No Date approved: DD/MM/YYYY Done