Together Fund Application Form Together Fund Application Form Organisation Name*: Contact Name*: Contact Email Address*: Contact Number*: Organisation website*: Organisation Postcode*: Active Dorset Contact*: - Choose - Martin Kimberley Charlie Coward Clive Nelson Claire Tabor Annie Hargreaves Katie Davies Georgie Messenger Steph Hendy Emma Forsyth Bradley Jones Tommy Cartledge Chloe Smith Rachelle Lawley Izabela Shylock James Day Unknown Organisation Type*: - Choose - Formally constituted club, association or trust Education Registered Charity Local Authority Social Enterprise Company Limited by Shares Company (limited by guarantee) Registered CASC Community Interest Company Unregistered Club or Association Other If other please specify Is the organisation a registered charity or company?* Charity Company Neither Companies House/Charity comm no. (if applicable)*: Which is the main social media platform this organisation uses?* - Choose - Facebook Instagram LinkedIn TikTok Twitter YouTube Other None Other Has this organisation received investment through a previous round of Tackling Inequalities Fund?* Yes No If yes, how much funding was received previously and what was the learning/impact of the investment?* Select the primary activity that is relevant to this project. For example; gymnastics, netball, yoga*: Main Beneficiary Delivery Postcode*: Please enter the main beneficiary delivery postcode, if you have multiple delivery sites, this could be the same as your organisation postcode. Please ensure capital letters & a space between the outward code (initial 2-4 characters) and inward code (final 3 characters) e.g AB12 3CD. Project Purpose*: Select the purpose/s which are relevant to this project. Select all that apply. Organisation survival Direct project delivery Resilience Support Work PA opportunities - in person Other Will this investment impact upon at least one of the four priority audiences? (Low socio-economic groups, people with a long term health condition, disabled people, culturally diverse communities)*: - Choose - Yes No Has the requirement arisen as a direct result of this community group or audience being adversely affected as a result of COVID-19?* - Choose - Yes No Briefly describe your project and where it is going to be delivered. * What issues does the funding help to resolve in improving access to take part in sport and physical activity for the target audience?* Will this investment help a community group to recover and grow or continue to survive as a result of hardship? If hardship, please set out in the application how this investment will enable the community organisation to continue beyond the immediacy of this short-term investment.* Is this project directly funding the provision of physical activity or if not, how will it support the delivery of physical activity in the immediate future?* Expected Participant Numbers*: How many people are expected to be supported to be more active counting each person only once? If you don’t have a precise figure, please provide an estimate. Select the groups who will benefit from this project*: Select only one of the following Culturally diverse communities Disabled people Lower socioeconomic groups People with long term health conditions Other Other main beneficiaries*: Select one or more of the following where relevant or leave blank. Faith communities LGBTQ+ people Migrants Older people Younger people Women and girls Children and young people Other Total Proposed Investment (£)*: Maximum investment is £10,000. Round to the nearest pound e.g 397 Budget Breakdown*: Please select all that apply. - Choose - Equipment Hire / Purchase Coaches Fees / Expenses Hire of Facilities Promotion / Publicity Staff Costs Transport / Travel Other Provide some more specific budget breakdowns here*: Provide a breakdown of the total cost e.g. Staff Costs total is £240 - 12 hours x £20 Start Date*: End Date*: Please note all Together Fund awards must be committed and spent by 31st March 2023 Additional Comments*: Add any further information here which is relevant to the application, but has not been covered elsewhere. Select 'yes' if you would like to be added to our newsletter subscription list: - Choose - Yes No
