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Project Application Form
For consideration by the East Sussex / West Sussex / Whitehead / Sheffield /Hampshire / Dorset / Thames / Essex / Kent / Somerset (Walpole) or Somerset (Dimmer)
panel(please circle as appropriate)
Total Project Cost
Amount Applying For
% of total cost %
It is important to read the Guidance Notes before you fill out this form. Ifthe form is not completed in full it will be returned and your application
delayed.
Please return form to: For Office Use OnlyDate Received
Reference No
Bob Attwood
Administrator
Viridor Credits Environmental Company
Aintree House
Blackbrook Park AvenueTaunton
Somerset
TA1 2PX
01823 624 656 : [email protected]
Applicant
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SECTION 1 ORGANISATION DETAILS
a. Name of Organisation or Applicant
___________________________________________________________________________________
b.Contact Details
Name_______________________________________________
Address_____________________________________________
___________________________________________________
___________________________________________________Postcode_________________
Position____________________________________________
Telephone________________________ Fax__________________ E-Mail_______________________________
______________________________________________________________________________________________________
c. How is your group constituted? E.g. Voluntary organisation, company, trust, other(please specify)
______________________________________________________________________________________________________
d. Provide details on the background to your group and its aims and objectives
______________________________________________________________________________________________________
e. Date of establishment of your organisation_____________________________
f. Provide details of relevant insurance policies
_____________________________________________________________________________________
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SECTION 2 PROJECT DETAILSA. GENERAL
Name of Project
____________________________________________________________________________
Name of and Distance from landfill site. ______________________We only look at applications that are within a maximum 10 mile radius of a Viridor Waste Landfill Site. Inthe case of the Thames, Beddington Landfill site this radius is reduced to 5 miles.
Location of Project e.g. Address, Post code etc.
____________________________________________________________________________________
Is your project registered with ENTRUST? If yes, please give project approval number.
(Please provide copy of approval) (Registration with ENTRUST is not a prerequisite as wecan register for you).
_____________________________________________________________________________________
Describe your project including its aims and objectives
_____________________________________________________________________________________
Describe why there is a need for the project
_____________________________________________________________________________________
Provide a proposed timetable of work including project start date and date of completion(projects must be started within 12 months of application)
____________________________________________________________________________
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Indicate which objectives your project contributes to (you may tick more than one box)
Reclamation, remediation, restoration or decontamination of land
for economic use for environmental use
for social use to reduce or prevent pollution
_____________________________________________________________________________________
Public Amenities and Parks
provide a new local amenity protect an existing amenity
improve an existing amenity other
_____________________________________________________________________________________
Building / Type of Facility
of historical interest for residential use
of architectural interest for educational use
for social or recreational use other
____________________________________________________________________________
Environment
improve local environment a improve access
increase public awareness increase biodiversity
habitat environment other
____________________________________________________________________________
Community Involvement
encourage local participation allow local decision making
involve community in development meet a local need
take into account under-represented groups other
____________________________________________________________________________
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CATEGORYd/da ONLY
Category d allows for the provision and maintenance of public amenities and parks.Such projects must be within the vicinity of a Viridor Waste landfill site and the facility
must be open to the public and not operated for profit. We are unable under theregulations to fund school projects.
Category da allows for the conservation and promotion of biological diversity. Thismust be connected to a specific natural habitat or a specific species. Such projects mustbe within 10 miles of a registered landfill site. We are unable under the regulations tofund school projects.
How large a community will benefit?
____________________________________________________________________________
Could this community be considered an adversely affected or deprived area?
____________________________________________________________________________
Does the project cover the natural or social environment?
____________________________________________________________________________
Is the ongoing maintenance of the projects focus or the projects area already agreed?
____________________________________________________________________________
What proportion of the total funding for the project are you applying to Viridor Creditsfor?
____________________________________________________________________________
What steps have been taken to ensure community support for the project?
____________________________________________________________________________
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CATEGORYda ONLY complete if relevant
What type of habitat and/or species are you working upon or with at this site? Projects mustbe linked to specific areas at a site or a specific species. We cannot register multi site applications.
____________________________________________________________________________
The protection of the environment. Please explain how this project will be for theprotection of the natural environment ?
____________________________________________________________________________
The conservation of biodiversity. Please explain how your project will lead toconservation or promotion of biodiversity in relation to this specific habitat or species ?
____________________________________________________________________________
Please indicate what support you have from partners in the biodiversity or conservationsphere?
___________________________________________________________________________
CATEGORYeONLY
Category e allows for the restoration and repair of buildings and structures that are forreligious worship or of architectural or historical interest. To qualify under this categorythe project must be within the vicinity of a Viridor Waste Management landfill site, be
open to the public and must be operated on a not for profit basis.
Why is this building or architecture unique? How special? How high profile?
____________________________________________________________________________
How urgent are the repairs and if not undertaken how significant would any damage beto the whole structure?
____________________________________________________________________________
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ALL CATEGORIES
Does the project have spin-offs in other categories?
____________________________________________________________________________
Indicate how the project will be managed, maintained and funded in the long term
____________________________________________________________________________
How do you intend to promote and publicise the project and in particular the award thatwe may make towards it?
____________________________________________________________________________
Has LCF funding been received before. If so how much, from whom and when?
____________________________________________________________________________
Have you applied to other LCF funders for this project? If so who and when do youexpect to hear?
____________________________________________________________________________
Please indicate below whether the project will result in any volunteer, training oremployment benefits
Output EstimatedNumber
Detail
Voluntary Opportunities
Vocational Training opportunities
Full-Time Jobs
Part-time/Seasonal Jobs
Other
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Youth VolunteeringIn 2006 the scheme was challenged by the Government to create new youth volunteeringopportunities. Consequently all applicants are required to provide the following information withregard to the project.
Outline definition for use with youth volunteering statistics:
A youth is someone who is between the ages of 16 and 25 when they start working on a project.
A volunteer is somebody who has offered their time to participate in the project and will receive nothing morethan reasonable out of pocket expenses whilst carrying out works on the project site.
Number of youth volunteers working on this project
Number of youth volunteering days created by this project
SECTION 3 SITE BASED/BUILDING PROJECTS ONLY
Who owns the land and/or building on which the project is sited?
_____________________________________________________________________________________
If you do not own the land and/or building, who has control over the land?
____________________________________________________________________________
If you have a lease or tenancy agreement please advise how many years remain we areunable to fund projects where short-life ownership rights exist.
Does the project require planning permission or other form of consent? Give details(attach copy)
____________________________________________________________________________
Designation of land eg. SSSI, AONB or of building eg. Grade II listed
____________________________________________________________________________
Do you have the relevant permission to carry out the Project?(provide details)
____________________________________________________________________________
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SECTION 4 FINANCE
How is your organisation currently funded? Give details of general income and funding,and of grants received in the past year. Also list contacts and partnership organisationswhich contribute to your income.
Income/grant Source/contact Timescale
What is the total cost for this particular project?(Please demonstrate how the total was calculated inquotes section at end)
____________________________________________________________________________
How much are you applying for from Viridor Credits?
____________________________________________________________________________
Third Party Contribution This is payable to Viridor Waste Management as they do not get100% tax relief (Only 90%) for the amount they give to the scheme. Therefore a third partycontribution, equal to 10% of the grant awarded, is required. (This means that this sum is notavailable for the project)
Who will make this contribution?
____________________________________________________________________________
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If the grant you are applying for is greater than 5,000 also enclose a detailed costingbudget with timeframes clearly identified. If requesting more than 20,000 a morecomprehensive business plan will be required._____________________________________________________________________________
List other funding for this project
Source of funding Amount requestedAmount confirmed/expected date of decision
Total
Please give details of the organisations bank account
Bank Sort Code
Branch Account No
Title of Account
If you are applying for a grant of less than 5,000, specify expenditure below, withtimescales
Item Cost Timescale
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Enclosures (Tick if supplied)
Constitution, Trust Deed or Memorandum & Articles of Association (compulsory)
Note of formal agreement of the organisation to apply for funding, e.g. relevantminute of meeting (compulsory)
ENTRUST Enrolled Environment Body registration letter (if registered) in mostinstances Viridor Credits will act as the Environmental body for you
ENTRUST Project registration letter (if obtained)
Evidence of other contributions and specific partner support for project(compulsory)
Evidence of Local Support (compulsory) this shows evidence of the projects worth to thelocal community
Documentation in evidence of the need and support for the project (compulsory)
Audited annual accounts (for last 2 years, where appropriate)
Quotations(s) for work to be undertaken on the project (compulsory) -aMinimum of3 Quotes are required by ourselves to satisfy the scheme regulations. Failure to providethese may lead to a delay in consideration of your projectPlease provide details below (Breakdown)
Grant Payments Schedule (if more than 5,000)
Capital works specifications (if requesting more than 5,000, if appropriate)
Job description/s for salaried posts please note however that only in very exceptionalcircumstances will we provide funding for salaried posts.
Budget and Cash flow plan (if requesting more than 5,000)
Business plan (if requesting more than 20,000)
Planning permission/consents/other relevant permission (if appropriate)
Site plans (if available)
Photographs(if available) Please include a few relevant photographs of the project site/area etc.They always help give our panels a feel for what you are asking for
Other relevant material (please specify)
Access Statement (provide on headed paper) this is compulsory for all projects and failure toprovide will lead to your application being delayed
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If the committee agrees to provide funding will you:
Be prepared to sign a formal agreement guaranteeing the proper use ofsuch funds in accordance with the Landfill Tax regulations;
Agree to provide progress reports to an agreed format and frequency;
Provide any information required by ENTRUST;
Provide and put in place an agreed publicity programme;
Keep proper audited accounts for the project and make them available tous or our advisors on request;
Make the first draw down of payment within 3 months of award approval,subject to project start date.
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Declaration
I confirm to the best of my knowledge that the above information is correct and that theproject will be carried out as described.
Signature Date
Name
Position
QuotesFrom
Details Total
1 Name
2 - Name
3 - Name