Ref:

FUNDING Year : 20 /20

Name of Organisation _____________________

Eligibility Check:	Related questions	Yes	No
1.	The application is from a non profit-taking group i.e. any profits made are re-invested back into the organisation.	Q4
2.	If they are a Voluntary/Community Group do they have an adopted constitution or set of rules?	Should be attached to application
3.	If they are a Statutory Body, have they enclosed their most recent signed Statement of Internal Control ?	Should be attached to application
4.	Are the most recent annual accounts or, for new organisations, a statement of income and expenditure enclosed, and have they been approved by an office holder or auditor?	Should be attached to application
5.	Has the organisation enclosed a copy of most recent bank statement?	Should be attached to application
6.	Does the organisation have a separate bank account?	Q7
7.	Are there at least two unrelated authorised cheque signatories?	Q8
8.	Has the organisation robust management and financial control procedures in place to administer the clear and transparent use of public funds?	Q9
9.	Are the funds requested between < > and < >?	Q10
10.	Does the organisation intend to spend the funds within the relevant funding period?	Q18

11.	Has the organisation enclosed a list of current Committee or Board Members, Trustees or Directors?	Should be attached to application
12.	Has the organisation enclosed an organisational chart clearly demonstrating management structure and accountability arrangements?	Should be attached to application

Result of Eligibility Check:
Pass to next stage:	Application Rejected:
If application is rejected, give reason why:
Assessors Signatures:
Name:	Date: