SUMMARY AUTHORISATION FORM

Total Programme Budget: £ ____________	Source of Funding	________________________

(Specify if budget is recurrent/non-recurrent)

POC/Health Improvement Area (sub-theme)	______________________

Date of Panel:	_____________

(Rank in order of panel agreed priorities)

No	Organisation	Title of Project	Funding awarded	Period of Award	LCG area
Total	FYE	In-Year Effect
1
2
3
4
5
6

Signed:	______________________

Programme Lead/

Health Improvement Lead