Environmental and Biodiversity Grant Application Form

Please check before sending that:

• Your project or service is based in and/or or benefits Berkhamsted;

• You have read the Environmental and Biodiversity Grant Policy;

• You have attached all additional documents required.

* Required Field

Environmental and Biodiversity Grant Application Form (up to £5000)
Name of Organisation*:
Correspondent (and position)*:
Address*:
Postcode:*
Telephone Number (s):*
Email Address:*
Please describe the nature of your organisation’s activity:*	(Limited to 5000 words)
Is your organisation a registered charity?*	Yes No
If yes, please give the charity number:
Is your organisation part of, or affiliated to, any national organisation?*	Yes No
If yes, please give details:
What is the catchment area of your organisation?*
Briefly describe the project or purpose for which you require a grant*:
Please describe how the project will benefit the community or residents of Berkhamsted*:
Please describe how the project will benefit the environment or diversity of Berkhamsted (refer to the Environmental and Biodiversity Grant Policy when answering this section and use additional paper if required)*:
Please give an estimate of any GHG/CO2 saving or potential mitigation benefit you expect your project to deliver and over what period, e.g. if the project or activity is related to a biodiversity gain, for example, a tree would be expected to offset a cer*: Please give an estimate of any GHG/CO2 saving or potential mitigation benefit you expect your project to deliver, e.g. if the project or activity is related to a biodiversity gain, for example, a tree would be expected to offset a certain level of CO2 over its lifetime.	(Limited to 5000 words)
Is your organisation VAT registered?*	Yes No
If yes, please provide the VAT number:
When do you intend to start the project?*
When will the project be completed?*
FINANCIAL ASSESSMENT
Please provide a breakdown of the total cost of the project
VAT (if applicable):
Total estimated cost of project*:
Please detail how your organisation plans to fund the project*:
Funds immediately available from your organisation: £:
Funds that you intend to raise yourself from events: £:
Grants or loans applied for/confirmed from other organisations: £:
Grant requested from Berkhamsted Town Council: £:
Total funding of project: £:
Please give details of any reserves or savings held by your organisation:
Who should the cheque be made payable to?*
I declare that any grant made will be used solely for the purposes outlined in this application. I understand that Berkhamsted Town Council reserves the right to reclaim the grant in the event of it not being used for the purpose specified.
Name*:
Signed*:
Position*:
Date*:

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