COMMUNITY AND ENTERPRISE DEPARTMENT

COMMUNITY GRANT APPLICATION FORM 2011

Closing Date 31st January 2011

Date Received:-

Reference Number:-

ALL APPLICATIONS ARE TO BE MADE TO:

The Office of the Director of Community and EnterpriseBlock 4, Floor 1e

Civic Offices, Wood Quay.Dublin 8

By 5pm 31st January 2011.

SECTION 1 – GROUP/ ORGANISATION DETAILS

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Name of Organisation __________________________________________________________

Address __________________________________________________________

__________________________________________________________

Postal District __________________________________________________________

Tax Clearance Cert/Charity Status Number (if applicable) : ___________________________

Expiry Date: __________________

Is your Organisation affiliated to the Dublin Community Forum? Yes / No( Please circle which is appropriate)

Contact Name __________________________________________________________

Telephone No. ___________________________________

E-mail ___________________________________

Bank Details of Organisation

Account Name ____________________________________________________________________

Bank Address ____________________________________________________________________

Sort Code ____________________________________________________________________

Account Number ___________________________________________________________________

COMMUNITY GRANT APPLICATION FORMSECTION 2 - PURPOSE OF GRANT

Note: The City Council will support community activities at neighbourhood level promoted by voluntary groups eg. festivals, environmental activities, older persons activities, heritage/historical projects etc. The City Council under its Community Grants Scheme will not support sports activities eg. football clubs nor will it provide funding for the employment of staff. For further advice and information please discuss your proposal with your local community development staff member.

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What is the purpose of the Grant?

___________________________________________________________________________________

Who is going to participate in this project and how many participants will be involved?

___________________________________________________________________________________

Where will this project take place?

___________________________________________________________________________________

___________________________________________________________________________________

Commencement Date ____________________ Completion Date__________________________

Description of the Activity

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

COMMUNITY GRANT APPLICATION FORM

SECTION 3 - FUNDING

SECTION 4 - DECLARATION

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DECLARATION

I declare that the information supplied is accurate and complete.

I understand that all information provided in respect of the Grant Application will be held electronically and may be made available to other Dublin City Council Departments as appropriate.

It should be noted that the Freedom of Information Act applies to all records held by Dublin City Council. (The application must be signed by either the Chairperson, Secretary or Treasurer of the organisation making the submission).

Name (please print) ___________________________ Date ________________________

Signed ______________________ Chairperson/Secretary/ Treasurer (delete as appropriate)

How much is the overall cost of the project? _________________________________

How much is being applied for under the DCC Community Grants Scheme?

_____________________________________

Please provide details of other funding already received for the project/event:

Name of Organisation: _______________________________________________________

Amount Received: _______________________________________________________

Date Received: _______________________________________________________

Please provide details of potential income:

Name of Organisation: ________________________________________________________

Amount: ________________________________________________________