Form - Brian Murtagh – Charitable Trust

Application Form (Stage 2)

Brian Murtagh Charitable Trust (BMCT) Grant Application Form

Please read our Guidance Notes on the website carefully before completing this form to ensure that your charity is eligible and the activities for which you are seeking funding match our terms of reference.
Please ensure that all sections of this application form are fully completed and that you include all the relevant documents required for submitting an application (see guidance notes).
Please adhere to the word limits where they are stated.
Please follow the instructions at the end of the form.
This form will not save as you fill it in.
Fields marked with a red asterisk * are mandatory/required fields.

Date Received:

Total Requested:

BMCT Code:

Submission date: 18th April, 2024 @ 23:19

1. Name of Organisation *:

Charity Number / Company Number:

Other not for profit status:

2. Project Name/Title *:

3. Name of Contact Person *:

4. Position in Organisation *:

5. Contact Address *:

Postcode *:

Telephone Number:
NB. if your phone numbers are not available Monday to Friday 9.00am to 5.00pm please state a time and day when a trustee can contact you. Please do NOT phone the charity. If you wish to communicate please email admin@brianmurtaghct.org.uk

Mobile number:

Email address:

6. Address of Organisation (if different):

Postcode:

Telephone Number:

Website address:

7. Bank Account Details:

Name on the account:

Account number:

Sort code:

Organisation Details:

8. Briefly describe *
i) which countries you operate or if UK based where in the UK.
ii) the aims, objectives and activities of your organisation:

9. Let us know how many people are involved in your organisation:

Paid staff Full Time:

Paid staff Part Time:

Volunteers:

Trustees:

Service users / members & beneficaries:

10. What is the legal status of your organisation? (more than one may apply):

11. Is it part of a larger or national organisation? If so, please describe.:

12. In which year did your organisation start?

13. How did you find out about BMCT?

14. Has your organisation applied to BMCT before? If so, when, and what was the outcome?

15. What is the total annual income and expenditure of your organisation? Please use figures from your most recent annual accounts or projected cash flow forecast if no annual accounts exist.

Income:

Expenditure:

Restricted reserves:

Unrestrictied reserves:

Project Details

15. What is the amount of funding required?

16. Describe the work you are asking us to fund:
If you have a budget breakdown for this project please include it with the form.

A. What outcomes do you hope to achieve with this funding?

B. What activities do you plan to deliver and over what period?

17. How will you monitor and evaluate the work that you are planning to deliver with this funding?

18. When do you need the funding to start? When is the end date or if it is ongoing then over how many years is this funding needed?

19. If the total cost of the project is greater than your request to BMCT please explain how you will raise the remainder. If you are applying to other funders, please tell us when you expect to hear the outcome of your application.

20. Please send an email separately to admin@brianmurtaghct.org.uk for:
A) Latest set of accounts ( draft will suffice)
B) Child safety and safeguarding policies.
C) A signed copy of the application form.

NB this MUST be sent immediately after you press the "send" button for the application form.

Thank you for completing this part of the form. Please enter your email address - a PDF copy of this form will be emailed to you to print out and send to the address below:

Declaration - to be signed when printed

This declaration should be signed by the applicant.

I am an authorised representative of -Name of charity

To the best of my knowledge the information provided on this application form is correct.
If BMCT agrees to make a grant this will be used exclusively for the purposes described. If a significant change occurs that has a direct effect to the purpose of the funding I will inform BMCT immediately.

Name (print)

Sign

Position

Date

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