Community Fund Application Form Application Form Please read the guidance notes before completing the form. If you need any help completing your application please contact Neil Golightly, Communications and Engagement Manager, by calling 0800 990 3405 or by emailing neil.golightly@cairnha.com. You can save your progress at anytime by clicking 'save and continue'. You'll get a unique web address which you can click on at anytime to return to the form where you left it.Name of project* Name of Registered Tenant Organisation (if applicable) or Group* Type of group (Charity, Informal, Constituted, etc)Do you have public liability insurance? Yes No Contact DetailsName Address Address Line 1 Address Line 2 Town/City County Postcode Contact Telephone numberEmail address* Website address or social media details Where will your project take place?Does your project involve working on a piece of land or building? Yes No Do you know who owns or leases the land or building? Yes No If yes, please provide detailsIs planning permission likely to be required? Yes No If yes, have you received planning permission? Yes No About your projectYour project must meet at least one of the followingPlease tick all that apply It has a focus on Cairn tenancy sustainment or financial inclusion.For example: starter pack or furniture projects, to help support tenants moving from temporary accommodation to a secure tenancy, projects providing financial guidance and support to Cairn tenants or projects tackling fuel poverty. It will enhance the quality of life in communities.For example: projects that promote safe, healthy and vibrant communities or provide support for events that encourage community cohesion. Create environmental improvements.For example community clean-up projects, community allotments and garden projects or healthy eating projects. It will encourage tenant participation that will positively impact on Cairn tenants and their families. It will reduce isolation or improve health.(Mental and physical). It will encourage partnership working or engagement with other organisations that will benefit Cairn tenants/residents/communities. Please give us a brief outline of your project. What are you going to do, where you are going to do it and who will be involved.Have you consulted with the local community on your plans? Will the local community be involved? If so please provide detailsWhen do you plan to carry out the project and why do you want to do it then? Please also confirm how long you expect it will take to complete the projectWhat will be the outcomes and impact of the project? How will this positively impact on Cairn tenants and residents or the communities in which they live?Is there any other relevant information that you wish to give us in support of your application?Please include relevant information on volunteer involvement or partnership working, etc.Project costsPlease provide details of the total cost of the activity, even if you are not requesting the full amountExample: TO HIRE A SKIP FOR ONE DAY £70 Use the button to add as many rows as you need.DescriptionCost (£) Total cost (£) Please tell us the amount of funding you are requesting from the Cairn Community Fund (£) If applicable please indicate how you are intending to raise the remaining balance and from what sourcesHave you already secured other funding? If so please provide detailsIf the application is successful who should the cheque be made out to? Conflict of Interest DeclarationAre you, or is anyone else involved in this application or in your group/organisation, a member of Cairn staff or a volunteer who sits on the Cairn Board? Yes No If yes, please provide detailsDo you, or anyone else involved in this application or in your group/organisation, have any close relatives who are members of Cairn staff or volunteers of Cairn’s Board? Yes No If yes, please provide detailsSignaturesTwo people must sign this application form. One should be the contact person named in section 2, and the other should be someone lese closely involved with the project. Please note that by signing this form the signatories are confirming that the information given in this application is complete and accurate. The provision of inaccurate or false information will invalidate your application. Signatory 1Name Signature Reset signature Signature locked. Reset to sign again Position in project Date DD slash MM slash YYYY Signatory 2Name Signature Reset signature Signature locked. Reset to sign again Position in project Date DD slash MM slash YYYY Please provide the name of a referee who can support your application (this could be a member of Cairn staff or a prominent member of the community such as a Councillor, MSP, GP or Police Officer).Name Contact DetailsPhoneThis field is for validation purposes and should be left unchanged. Δ
