Application Form for Newly Formed Rural Youth Clubs

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About Your Organisation
In the fields below, please give a short, clear description of the proposed new Rural Youth Club.
Name of organisation, or proposed organisation, making the application*
Establish a new Club as follows:*
Timetable for starting the new Club is as follows:*
Methods by which the objectives will be achieved:*
Names of individuals involved in the running of a new the names and addresses of the intended leaders:*

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Extra information
Where pump-priming for a new club is being sought, please give the following additional Information:
Approximate number of young people who may be involved, naming the catchment area from which they will come:
Meeting place of proposed new club:
Projected club programme for the next six months including any special activities:
Financial position of the club for the next six months:
Please confirm this club/ organisation does not have any dormant finances held by a third party:*
This could include a dormant bank account, monies held by a county federation etc.
Any additional information that you may consider relevant:

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Bank Details
It would be helpful if any grant awarded could be paid electronically to your bank account. Therefore, please, complete the following:
Name of account*
Branch Sort Code*
Account Number*

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Details of person making the application
Name*
Prefix First Last
Address*
Address Line 1 Address Line 2 Town/City County Postcode Country
Phone Number (Home)*
Phone Number (Work)*
Email Address*
The following declaration must be completed by the person who is responsible for making the application:*
I am an authorised representative on behalf of the organisation/group of people making this application.
*
I declare that, to the best of my knowledge and belief, all the information given to this application form is correct and any grant awarded will be used for the purposes stated.
*
I understand that the condition of the Grant is that a report must be submitted to the Trust Secretary within three months of the completion of the project.
*
I confirm that all photographs/images submitted in the Report may be used on the Rural Youth Trust’s website. I have secured the permission of anyone featured in the pictures for publication including parental consent for any children featured.
*
I declare that, the organisation/group of people making this application, are happy that the Rural Youth Trust retain data for the sole purpose of recording applications made to or granted by the Rural Youth Trust. The data is held securely by the Trust Secretary and applications will be destroyed after seven years. Evaluation forms will be retained indefinitely.
Signature*
The decision of the Trustees on any application is final and binding. No correspondence can be entered into and it is regretted that no responsibility can be accepted for any applications lost, delayed, mislaid or damaged in the post or otherwise.

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Step 1 of 4

About Your Organisation

Extra information

Bank Details

Details of person making the application