Communities Mental Health and Wellbeing Fund for Adults - Round 5 Application Form
2-Year Main Grant
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1 Uppercase letter
1 Lowercase letter
1 Number
1 Special character
Section 1 - Contact Details
Organisation Name
Street
Town
Postcode
Telephone
Website
General / Office Email
Are you part of a larger regional or national organisation?
Please select...
Yes
No
Main contact person
These are the details that will be used for correspondence purposes
Title
Forename(s)
Surname
Job Title
Work / Office Phone
Mobile Phone
Email
Secondary contact person
These are the details that will be used for correspondence purposes if the main contact is unavailable
Title
Forename(s)
Surname
Job Title
Work / Office Phone
Mobile Phone
Email
Section 2- About your Organisation
When was your organisation established?
What type of organisation are you?
Please select...
Scottish Charitable Incorporated Organisation (SCIO)
Registered Charity
Company Limited by Guarantee
Trust
Not-for-profit company or asset locked company or Community Interest Company (CIC)
Cooperative
Community Benefit Society
Community Council
Parent Council
Please check the relevant box(es) and input the charity and company numbers where appropriate. All Scottish charity numbers start with SC. Please enter your number without spaces i.e. SC012345 not SCO 12345.
Charity Number
Company Number
Staffing and volunteers - How many of each of the following are involved in the organisation?
Full time staff
Part time staff
Trustees
Volunteers (excluding management committee)
Briefly describe the purpose of your organisation, outlining the main activities and services you provide and to whom.
Section 3 - Financial details
What was your total income over last accounting year?
£
Your annual income must be no more than £1million. If you are part of a national organisation, this amount would refer to the income specifically for Dumfries and Galloway.
Please state the name, position and company details of the independent examiner who has signed your accounts.
Bank Account Name
Do NOT provide the name of the Bank/Building Society.
Bank Account Number
Bank Sort Code
Do NOT enter spaces or dashes
If your account name is different to the name of your organisation, please state the reason why.
Section 4 - Your project
Project Name
Project / funding start date
Start date cannot be before 01/04/2026
Project / funding end date
End date cannot be after 31/03/2028
Please confirm that this project will take place in Dumfries and Galloway
I confirm
In which postcode area(s) will the project take place?
DG1
DG2
DG3
DG4
DG5
DG6
DG7
DG8
DG9
DG10
DG11
DG12
DG13
DG14
DG16
KA6
ML12
How many beneficiaries will this project support?
How have you calculated this figure?
Which at risk group do your beneficiaries identify as?
Please select the three most prevalent characteristics that apply to your beneficiaries.
Refer to the Equalities considerations and at-risk groups stated within the guidance document.
Women (particularly young women, and women and young women affected by male sexual violence).
People with a long term health condition or disability.
People from a Minority Ethnic background.
Refugees and those with no recourse to public funds.
People facing socio-economic disadvantage.
People experiencing severe and multiple disadvantage.
People with diagnosed mental illness.
People affected by psychological trauma (including adverse childhood experiences).
People who have experienced bereavement or loss.
People disadvantaged by geographical location (particularly remote and rural areas).
Older people (aged 50 and above).
Lesbian, Gay, Bisexual and Transgender and Intersex (LGBTI) communities.
Neurodiverse communities.
Young people aged 16-24.
Who can benefit from this project?
Please select...
General (open to all)
Targeted (you are targeting the identified risk group)
Restricted (the project is only open to the identified risk group)
Please identify if this a new project, new to this fund or existing funded project.
Please select...
New Project (Not received funding from anywhere before)
Previous CMHWF Project (Project has been funded by this fund in a previous round)
Existing Project (Project funded from elsewhere and this is the first application for this project to this fund)
Which description best matches project?
Please select...
Befriending
Peer support
Counselling
Therapeutic
Mentoring
Financial inclusion/cost of living
One to one
Group activity
Equipment
Food
Nature
Social
Arts and crafts
Maintenance/repair
Sport or physical activity
Culture
Other
If
Other
please provide a short description
How many volunteers are involved in the delivery of this project?
Does this project target any of the Scottish Governments cost-of-living priority groups? Please tick all that apply
Lone parents
Families with a disabled family member
Families with 3+ children
Minority ethnic families
Families where youngest child is under 1 year old
Mothers aged less than 25
Please tell us about your project and the activities you would like to deliver.
Please tell us why this project is needed, including any evidence you have to support this claim.
What difference will this project make to its beneficiaries (Adults over 16)?
Please identify which of the funding programme priorities your project will address:
Social Isolation and Loneliness
Suicide Prevention
Poverty and Inequality
Taking each of the priorities you have chosen above, please explain how your project will deliver these priorities.
Social Isolation and Loneliness
Suicide Prevention
Poverty and Inequality
Describe how you would measure your project’s impact?
Section 5 - Details of grant funding requested
What is the total cost of the project?
£
How much money is being applied for?
£
If you are not applying for 100% of the total project cost, please tell us where else your project funding is coming from.
Funder
Amount
Status
£
Please select...
Secured
Applied
Please provide a full breakdown of the grant requested according to your Year 1 and Year 2 budget.
Ensure the breakdown adds up to the amount you have applied for, and not the project total cost.
Please provide the calculations for each item in the tables below.
Year One
YEAR ONE BUDGET AMOUNT TO BE SPENT BETWEEN 01/04/26 AND 31/03/27
Item/Description
Cost
£
Sum of budget costs as described above for year one
£
Year Two
YEAR TWO BUDGET AMOUNT TO BE SPENT BETWEEN 01/04/27 AND 31/03/28
Item/Description
Cost
£
Sum of budget costs as described above for year two
£
Combined total for Year One and Year Two
£
Please ensure this total matches the amount being applied for
If you have applied for capital amount (under £5,000), please tell us about your exit strategy.
Section 6 - Supporting documents & confirmations
Please confirm you have the appropriate policies and procedures in place to deliver this project.
I confirm
Please confirm you have a safeguarding policy if your organisation’s core work or the project you are applying for involves children or vulnerable adults
I confirm
Not applicable
Please confirm that you have an EDI (Equality, Diversity, and Inclusion) policy.
I confirm
This funding is subject to meeting the principles of the Fair Work Framework as described in section 3.1.5 of the guidance. Please confirm that you will adhere to these requirements.
I confirm
If your grant request is for any item(s) costing more than £3,000 please confirm that you obtain at least two quotes for each of those items.
I confirm
Not applicable
A copy of a recent bank statement with your bank name, account name, sort code and account number will be uploaded with your application.
A copy of your constitution (or other governing document) submitted with the application is the most up-to-date version adopted by the members of the organisation.
If you do not have the bank statement available electronically, please submit the application and email it as soon as possible to
wellbeingfund@tsdg.org.uk
All your documents must be received within 5 days of submitting or by the application deadline, whichever is sooner.
Please note that your application may not be processed for assessment until all the required documents, listed above, have been received.
Section 7 - Declaration
I declare that the information contained in this application is correct, and that I am authorised to make the application on behalf of the named organisation and with whom it has been discussed. I understand that decisions made by the scoring panel are final.
Full name
Date
By submitting your application, you agree to allow Third Sector Dumfries and Galloway to retain your personal data on its database to process your application. We will use the information you give us to help assess your application and administer any grant we award you. We may also publish this information on our website or use it to analyse our grant making for our own research or for others. We may give copies of this information to individuals and organisations we consult when assessing applications, when monitoring grants and evaluating our programmes. We may also use this information for training purposes. This is in line with our Privacy Notice which you can read at
www.tsdg.org.uk
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