The Hilden Charitable Fund

charity number: 232591

Application Form  Which Hilden Priority       Asylum Seekers & Refugees Community Based Initiatives for Disadvantaged Young People Homelessness Penal Affairs Overseas Development <\SELECT>

SECTION 1 Contact  Details                                                                          Date Sent: (dd/mm/yyyy)

1. Name of Organisation

2. Name of Contact Person

3.  Job Title

4. Contact e-mail

5. Contact phone number

6. Address                                                                                                                                                                                Postcode                                Country

7. Organisation website

8. How did you find out about Hilden?

9. If a registered charity in the UK please give your charity number

10. Have you been funded by Hilden before?      Yes No    If Yes please give the date

11. If registered overseas give NGO status details

12. Please give the year in which your organisation was set up

SECTION 2 Grant Request

13. In a few sentences say what your agency does and the purpose for which you need grant aid. (NB text does not wrap round) 13a.   13b. 13c.   13d. 14. Amount Requested from Hilden    If the amount you are requesting is for an overseas partner please ALSO  complete questions about your partner profile

15. How much have you raised towards the project so far?

16. Is the grant for on-going work?     Yes                 No

17. If the grant is for work to commence on what date will it start?

18. How many people will benefit from this grant?

19. If the project involves direct contact with children or vunerable adults,have you taken appropriate protection measures? Please give details.

20. Do you calculate a unit cost to measure your impact?If YES give details

SECTION 3 Your Human Resources

21. How is your governing body constituted?                                                               Self-appointment Election from members <\SELECT>       If membership how many members have you?

22. How many people are on your Governing Body?

23. How many people do you employ?                                                                                  What is that in full time equivalents?

24. How many volunteers do you involve across the organisation?

25. Approximately what was your total volunteer cost in the last financial year?

SECTION 4 Your Finances

26. Please give the date of your last Inspected Annual Accounts and Annual Report       Year ending

27. From your last inspected accounts please give the information below. Overseas charities please give the amount in local currency and £UK equivalent

£UK                           Overseas

28a. What was your total income?

28b. What was your total expenditure?

28c. What were your net current assets?

28d. What were your balance sheet funds? (or surplus / deficit carried forward)

28e. How many months running costs are covered by your reserves?

28f.  How much of your balance sheet is restricted and unrestricted?   Restricted  Unrestricted

SECTION 5 Your Funding Sources

29. UK charities please complete your funding sources below. Overseas agencies please give details of your funding sources in question 27 below

Funding Source                                         %                                                                                           %

29a.  Statutory                                        e.  Earnings from activities

29b.  Lottery funds                                 f.  Investment Income

29c.  Private companies                         g.  Grant making  trusts

29d.  Individual donations                      h.  Other

30.    Do you claim gift aid?                Yes No

SECTION 6 Overseas Charities ONLY

31. Agencies applying from Overseas please give details of your funding sources below. Of your last year’s income what was the percentage funding from:

31a. Sources within your country

31b. Funding from UK

31c. Funding from other countries

Please name below your 3 largest donors

1

2

3

PLEASE REMEMBER TO HAVE YOUR APPLICATION CONSIDERED:

UK agencies who are applying in support of their partner overseas please complete the PARTNER PROFILE Section below, OTHERWISE finally please return by post this completed form and your letter of application (2 sides of A4), annual report and accounts (plus any other attachments you feel relevant) to: Hilden Charitable Fund 34 North End Road, London W14 0SH

Overseas Partner Profile click here  Form completion The form can be saved using Mozilla Firefox. In Internet Explorer you can save and edit the form by using the option “Edit with Microsoft Word” This can be found either under “File” menu or under “Page”   Please go into print and print at 104% and print the form off to send to us Back to home page

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