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What are you contacting us about?

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  Full Name*

  First Name Last Name

  Contact Information

  Email Address*

  Phone**

  Postcode

  House Number or Name*

  Street*

  Town*

  County*

  Postcode*

  Write us a message*

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• "*" indicates required fields

  Antisocial Behaviour Details

  Please give as much detail as you can.

  Full Name*

  First Name Last Name

  Sharing Information

  Are you happy with us sharing your information with involved agencies?

  Contact Information

  Email*

  Phone*

  Postcode

  House Number or Name*

  Street*

  Town*

  County*

  Postcode*

  Incident Location

  Incident Location*

  Incident Date and Time

  Date of the incident*

  DD slash MM slash YYYY

  Time*

  Hours

  :

  Minutes

  AM PM AM/PM

  Incident Description*

  Please give as much detail as you can. Include how the incident has impacted you, and your involvement.

  Have you taken steps to resolve the issue before contacting us?*

  Yes

  No

  Let us know what steps you’ve taken

  Is the alleged perpetrator known to you?

  Yes

  No

  Perpetrator (Alleged)

  Their details if you know them

  Perpetrator Contact Information

  Perpetrator (Alleged) Address

  Are you happy to allow us to make contact with the person identified above?

  Yes

  No

  Please be aware that where we have a duty to pass information to a statutory agency such as the police or Social Services, such as where a child is at risk, we will be speaking directly to the relevant agency giving full details of the situation. Please tick to confirm you have read and understood this.*

  Please be aware that where we have a duty to pass information to a statutory agency such as the police or Social Services, such as where a child is at risk, we will be speaking directly to the relevant agency giving full details of the situation. Please tick to confirm you have read and understood this.*

  I confirm the details I have completed in this form are accurate and true to the best of my knowledge and belief. Please tick to confirm you have read and understood this.*

  I confirm the details I have completed in this form are accurate and true to the best of my knowledge and belief. Please tick to confirm you have read and understood this.*

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  Community Development Grant Application

  We need some details about the group for grant submission

  Group Name

  Named contact person

  Name of contact

  Position within the group

  Group Contact Details

  Group Contact Details - Email address

  Group Contact Details - Phone

  Group Address

  Postcode

  House Number or Name

  Street

  Town or city

  County

  Postcode

  Is your group registered as either a charity or a business?

  Yes

  No

  Registration Number

  Is the group a voluntary/community/not-for-profit making organisation?

  Yes

  No

  Number of members in your group

  Please enter a number greater than or equal to 1.

  When was the group established?

  DD slash MM slash YYYY

  Objectives of the group

  Group Objectives

  Project Activities and Description

  Project Category

  Click the link to refer to the Guidance Sheet on the website.

  Digital Inclusion

  Young People

  Community Connections

  Inclusive Communities

  Employment & Skills

  Older People

  Living Well

  Domestic Abuse

  Healthy Communities

  Activity Description

  Location and Resident Benefit

  Which areas of Wythenshawe does your project/group cover?

  Baguley

  Benchill

  Brooklands

  Brownley Green

  Crossacres

  Moss Nook

  Northenden

  Northern Moor

  Peel Hall

  Poundswick

  Royal Oak

  Sharston

  Woodhouse Park

  All of Wythenshawe

  Benefit to residents

  Costs and Grant Usage

  Total Project Cost

  (Indicate the total cost of the project)

  Grant Request Value

  (Indicate how much you are asking for)

  Other Income

  (Please indicate whether you are receiving income from any other source(s), e.g. fundraising, other grants, membership fees / subs)

  Yes

  No

  Other Income Detail

  Intended Grant Use

  Members and Conflict

  Does your group have a Chair, Secretary and Treasurer or governing body?

  Yes

  No

  Names and roles

  Do you need to declare a conflict of interest?

  Do you or a member of your group work for Wythenshawe Community Housing Group? Are you or any members of your group related to a member of WCHG staff or board member?

  Yes

  No

  Conflict of interest details

  Group Conduct Documents

  Do you have a current constitution or set of rules for your group?

  Yes

  No

  Please attach a copy below

  Drop files here or Select files

  Max. file size: 8 MB.

  Bank Account Information

  Does your group have its own bank account?

  Yes

  No

  Bank Account Details

  Account Name

  Account Number

  Sort Code

  Your Bank

  Bank Address

  Street address

  Town or city

  Postcode

  Signatories

  We require 2 authorised signatories to sign on behalf of the group.

  Authorised Signatory 1

  Have they freely agreed to sign on behalf of the group?

  Have they freely agreed to sign on behalf of the group?

  Authorised Signatory 2

  Have they freely agreed to sign on behalf of the group?

  Have they freely agreed to sign on behalf of the group?

  Consent and Declarations

  Your consent and declaration

  We confirm that the information in this application is correct. Any information found to be false or misleading will lead to any grant offer being withdrawn. We understand you may ask for further information at any stage of the application process.*

  We confirm that the information in this application is correct. Any information found to be false or misleading will lead to any grant offer being withdrawn. We understand you may ask for further information at any stage of the application process.*

  Please tick here to confirm you have understood everything on this form and are happy to submit this information to Wythenshawe Community Housing Group for the purposes of this application. For more information click here to read our privacy statement .*

  Please tick here to confirm you have understood everything on this form and are happy to submit this information to Wythenshawe Community Housing Group for the purposes of this application. For more information click here to read our privacy statement .*

  Permission to share as good news story. (If your application is successful, and you are given a grant, we would require your project to share how the fund has supported your project and give us permission to share this as a good news story.)

  Yes

  No

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