Welcome to the Children's Play programme.

You can also get the information on this form in other formats by phoning 0845 4 10 20 30 (textphone for people with hearing impairments 0845 602 1659).

Before completing your application, please make sure you have read the guidance notes. These will help you fill in the form. Please write clearly in black ink or type.

There are four application rounds for this programme, with the following closing dates:

1. 24 July 2006

2. 13 November 2006

3. 12 March 2007

4. 10 September 2007

Please apply to one round only, by sending your completed application form to:

Big Lottery Fund

Children's Play Programme

Birmingham Operational Centre

8th Floor, Edmund House

12-22 Newhall Street

Birmingham

B3 3NL

If you have any queries about the application form or process, please contact us on

Telephone: 0121 200 3500

Textphone: 0121 212 3523

Fax: 0121 212 3081

Email: [email address]

Section 1: Organisation details

1.1 Organisation name

What is the legal name of your organisation (as shown in your governing document)?

1.2 Organisation address

What is your organisation's registered address?

1.3 Main contact details for the application

Fill in the following details about the person in your organisation who will be the main contact for your application. We will contact this person to discuss the application in more detail. They must be available to talk about all the individual projects in your portfolio.

If the address for correspondence is different from the organisation's registered address please tell us why.

Please tell us if we should be aware of any particular communication needs your main contact has. This might include textphone, sign language, large print, audiotape, Braille or a community language.

1.4 Organisation type

Please tick to confirm that your organisation is a local authority.

If you are not a local authority you are not eligible to apply for funding from this programme.

1.5 Your organisation's bank account

All organisations that receive a grant from us must have a bank or building society account in the name of the organisation as shown in your governing document. Cheques and withdrawals must be signed by at least two people who are not related to each other. You can send us an application form without having an account but you will need to set up an account before we can pay your grant.

Do you meet this requirement? Yes No

1.6 Your organisation's accounts

As you are a statutory body, we do not need you to send us your accounts at this stage. However, we may ask to see your financial records when we assess your portfolio.

1.7 Child protection / vulnerable adults

As you are applying for a portfolio that works with children, young people or vulnerable adults, please tick the box below to confirm that your organisation has child protection / vulnerable adult policies and procedures in place.

These must meet the standards set out in our guidance notes.

Section 2: About your portfolio

In this section please provide summary information for the portfolio as a whole. You must provide more detailed information about each individual project using Appendix A.

2.1 Name of your portfolio (in no more than 10 words)

2.2 Portfolio description

Briefly describe your portfolio and what it is intended to achieve.

2.3 Portfolio beneficiaries

Tell us about the people and/or organisations that will mostly benefit from your portfolio.

2.4 Individual projects list

You should list all the individual projects below in order of priority (with 1 as the highest). You should prioritise your projects on how important they are to achieving your outcomes, the programme outcomes and the priorities identified in your Children's Play strategy. You should also tell us the amount you would like from us towards each project. Check that your priority projects and management costs can be funded from your allocated amount. You must be able to tell us why you have prioritised the projects in this order as we may ask you to explain this during the assessment.

For each individual project you are also required to complete Appendix A.

Section 3: Assessment questions

This is your opportunity to tell us more about your organisation and your portfolio. Please read section 3 of the guidance notes carefully before completing this section, as this will tell you more about the information we require here. Your answer must cover all of the areas below, using the same numbered headings and in the same order. It should be no more than 20 sides of A4, either clearly handwritten or word-processed in no less than 12-point font.

Need and outcomes

3.1 What is the need for your portfolio and how have you identified that need?

3.2 What are the proposed outcomes of your portfolio?

3.3 How will your portfolio address the needs you have identified in your Children's Play strategy and bring about your proposed outcomes?

3.4 How will your portfolio help achieve the programme outcomes?

Portfolio management

3.6 Who will manage your portfolio?

3.7 What are the key milestones for your portfolio?

3.8 How will you manage your portfolio?

3.9 What are the main risks to your portfolio and how will you manage them?

About your organisation

3.10 How is your organisation managed?

3.11 How will you take into account equal opportunities in your portfolio?

Individual projects

3.12 How will the individual projects in your portfolio contribute to the overall strategy of
the portfolio?

Section 4: Your portfolio budget

4.1 Portfolio management costs

Fill in the following table to show us how much you need to support, monitor and manage the portfolio, what funding is anticipated from other sources and the total contribution required from us.

Make sure you read the programme guidance notes, as they will help you to understand:

Portfolio management costs

Please provide a breakdown for each year of your portfolio on the following table.

4.2 Total portfolio costs

This table should be completed to show the total cost of your portfolio. Fill in the total costs of all individual projects and the total management costs.

4.3 Amount requested from Big Lottery Fund

Use this table to tell us how much grant you will need from Big Lottery Fund each year for your portfolio (management costs and individual project costs).

4.4 Funding from other sources

If some of the money for your portfolio will come from other sources, tell us where the money will come from. Tell us how much it is and whether you have secured it yet.

*tick if applicable

4.5 Value Added Tax (VAT)

Is your organisation registered for VAT? Yes No

If yes, please give the VAT number.

Have you been in touch with either your local VAT office or a VAT expert to find out how much VAT you can recover on the cost of your scheme and do your budget costs reflect this?

Yes No

If you have answered `No' to the above question, describe below what you have done to make sure that you will incur no extra costs as the result of irrecoverable VAT. Can you meet any extra costs that may occur? This is important as we cannot increase our grant at a later date.

Section 5. Finishing your application form

While we will accept all other information electronically, you must provide original signatures. If you are emailing your application to us, you must send us a hard copy of this section. Please ensure that you send all of this section, pages 10 - 12.

Checklist

We have included this checklist to help you check you are sending us a fully completed application. Please tick the following boxes before you send your application to us:

Data Protection Act

We will use the information you give us on the application form during assessment and the life of any grant we award you to administer and analyse grants and for our own research.

We may give copies of this information to individuals and organisations we consult when assessing applications, when monitoring grants and evaluating the way our funding programmes work and the effect they have. These organisations may include accountants, external evaluators and other organisations or groups involved in delivering the project. We may also share information with other Lottery distributors, government departments, organisations providing matched funding and other organisations and individuals with a legitimate interest in Lottery applications and grants, or for the prevention or detection of fraud.

We might use the data you provide for our own research. We recognise the need to maintain the confidentiality of vulnerable groups and their details will not be made public in any way, except as required by law.

Freedom of Information Act

The Freedom of Information Act 2000 gives members of the public the right to request any information that we hold. This includes information received from third parties, such as, although not limited to, grant applicants, grant holders, contractors and people making a complaint.

If information is requested under the Freedom of Information Act we will release it, subject to exemptions; although we may consult with you first.

We will take your signatures on this form as confirmation that you understand our obligations under the Data Protection Act 1998 and the Freedom of Information Act 2000 and that you accept that we will not be liable for any loss or damage to you pursuant to our fulfilment to our obligations under the relevant law.

Declaration

We confirm that we are duly authorised to sign this declaration on behalf of the applicant organisation.

We certify that the information given in this application is true and confirm that the enclosures are current, accurate and adopted or approved by our organisation.

We understand that any offer of grant will be subject to terms and conditions and we confirm that the organisation has the power to accept this grant if the application is successful and to repay it if the grant conditions are not met.

We understand that, if we make any seriously misleading statements (whether deliberate or accidental) at any stage during the application process, or if we knowingly withhold any information, this could make our application invalid and we will be liable to repay any funds.

We understand that the Big Lottery Fund may commission an evaluation of the programme.

We confirm that we will co-operate with any evaluation related activities which are required of us by the Big Lottery Fund and further confirm that the Big Lottery Fund may use any part of our application for evaluation or research purposes.

We have not altered or deleted the original wording and structure of this application form as it was originally provided or added to it in any way.

We understand that you require each signatory to this form to provide their full name, address and date of birth for fraud prevention and detection purposes.

Name of the organisation as it appears on your governing document.

Signatory one

This must be the main contact named in section one.

Signatory two

This should be the chief executive of the local authority.

I confirm that this application and the proposed project within it has been authorised by the appropriate elected members or senior staff.

Section 6 - Beneficiary monitoring

Please note that this information is being gathered for monitoring purposes only and will not be used to assess your application.

1. Ethnic background of direct beneficiaries

Is your portfolio directed at, or of particular relevance to, people from a specific ethnic background?

No

Yes

If you have answered `No' please go to question two. If you have answered `Yes' please indicate the ethnic background of the people who will benefit from your portfolio, ticking up to three categories.

White

British

Irish

Any other White background

Mixed

Mixed ethnic background

Asian or Asian British

Indian

Pakistani

Bangladeshi

Any other Asian background

Black or Black British

Caribbean

African

Any other Black background

Other ethnic background

Chinese

Any other

2. Gender

Is your portfolio directed at, or of particular relevance to, people of a specific gender?

No

Yes if `yes', please tick Male Female

3. Age

Is your portfolio directed at, or of particular relevance to, people of a particular age group?

No

Yes if yes, please tick 0-24 years 25-64 years 65+ years

4. Disability

Is your portfolio directed at disabled people, or of particular relevance to, people with disabilities?

No

Yes