Welcome to the Heart of England Community Foundation application form for the Harry Payne Fund. 

Before you proceed with your application, please read the following information carefully.

You will process my details in accordance with the following policies and information:

• Privacy Policy

• Essential Information For All Applicants

Before completing this application form, please refer to our Fund Fact Sheets for the criteria of the Harry Payne Fund.

If you are unsure about applying or have any other queries then please contact our Grants Team on 024 7780 0520 or e-mail us: info@heartofenglandcf.co.uk and we will be happy to help.

Please note that the Harry Payne Fund will support core costs. If you are applying for core costs only you do not need to refer to a project or activity.

Good luck and we look forward to receiving your completed application.

The contact person should be someone who has a good knowledge of the application as this is the person we will contact if we have any queries.

As it appears on any governing documents.

We'd like to keep in touch with you during the grant application process and beyond, so please  provide your organisation's website and social media details if you have any.

Organisation legal status (select all that apply)

You will need to attach a bank statement from within the last three months at the end of this application so that we can check the account you want this grant to be paid into, if successful.

Bank address

If you do not have a name for the project, activity or service that is ok. If you are applying for core costs/ over heads please insert 'core costs'.

If your project, activity or service is on-going, you should enter the start and finish dates of the funding period.

We realise that you cannot give exact figures but please estimate as accurately as possible. This information is important and will be used to evaluate the Project, Activity or Service at the end of the grant period. 

To help us understand what you're planning to spend the money on, we would like you to provide a breakdown of your costs

These are the amounts you've entered on the previous page

These are the amounts you've entered on the previous page

If you are applying to us for the first time using this form, you need to attach all of the following documents. If you have applied to us using this form within the last 12 months, you only need to attach a recent bank statement.

By ticking the box below:

• You accept that if you leave the organisation or can no longer fulfill your responsibilities, or someone else takes over responsibility for the grant on behalf of the organisation, you must inform us immediately.
• You accept the terms and conditions of the grant as they are set out in this application form and the guidance notes.
• You certify that the information contained in this application is correct and that you are authorised by the organisation to accept these conditions on their behalf.
• You will only spend the grant for the purposes outlined in this application unless you have received written confirmation, from the Foundation, that you can make a variation of spend.
• You accept that the Foundation will, under no circumstances, be liable for any damage, injury or loss of any kind whatsoever to any property or persons occurring as a result of activities undertaken with this grant.
• You will ensure that all necessary permits and licenses have been obtained for any event or project funded by the grant and that the event or project complies with all relevant regulations.
• You acknowledge that you cannot sell or dispose of any equipment or other assets funded or part funded by the Foundation without first receiving written permission.  If any equipment or assets are sold within their working life without such undertaking, the Foundation can ask for a percentage of the original grant to be re-paid.
• You confirm that the grant will not be used for the provision of services to asylum seekers when those services are inconsistent with immigration laws or Home Office policy. You understand this includes, but is not limited to: the promotion of work based training to asylum seekers; the provision of employment to asylum seekers unless they are otherwise permitted to take employment; and the provision of services or activities, to asylum seekers, which are intended to assist with the integration of refugees.
• You accept that you must keep all financial records and accounts including receipts for items bought with the grant for at least 6 years. These must be made available to the Foundation if requested.
• You give permission for the Foundation to record the information in this form electronically and to contact your organisation by phone, mail or email with regards to this application.
• You accept that Heart of England Community Foundation may follow up on successful applicants and potentially feature them in publicity activities.
• You accept that if your application is successful, that you are willing to take part in, where appropriate, in any publicity activities.
• You agree to Heart of England Community Foundation collecting, processing, storing and sharing information provided on this application, as part of the assessment and monitoring process in line with their Privacy Policy. This includes the sharing of information on grant applicants with grant panel members, donors and approved suppliers e.g., marketing agency. We will also publish a full list of all successful grant recipients externally. This includes group/organisation’s name, amounts awarded, location and purpose of grant.