Group/Organisation name:

Address:

Name of person requesting the funding:

Role within organisation:

Email:

Telephone:

Where will the activity be delivered?:
FalkirkStirlingClacksForth Valley Wide

Describe the food activities that you plan to deliver:

How many people are expected to benefit from this grant and activity?:

Give details and names of any partners or groups involved with this project:

Will the project grant benefit any of the following groups?:
Children and Young PeopleAdultsOlder adultsAll age groupsBAME GroupsLGBTRefugeesPeople in Community Justice SystemHomelessness CommunitiesAdults with mental health issuesAdults with disabilityAdults with physical health issuesChildren & young people and their families/carersAlcohol and Substance Use CommunitiesDomestic Abuse CommunitiesTravelling CommunitiesOther, please specify below

Please provide additional details here:

List all items to be purchased with the grant money and include the cost per item:
(Remember to keep a copy of ALL receipts!)

Total cost of items:

How will this project be sustained after the funding has been spent?:

Please give details of any additional funding for this project:

Do you currently charge for activities?:
NoYes

Which of the following does the organisation have in place?:
ConstitutionSteering GroupManagement Committee

How did you find out about the Community Food Grants?
Social MediaWord of MouthColleagueNewsletterOther

We (the group/organisation) have read and agree to abide by the conditions governing the award of the Community Food Activity Grant.

We agree to submit a brief evaluation showing how the grant has been spent and the difference it has made locally within 6 months of receipt of funds.

We agree that the details supplied here may be held on file by NHS Forth Valley.

We agree that the details supplied here may be shared with other departments within NHS Forth Valley. (optional)