Hackney Youth Opportunity Fund - Young Hackney

APPLICATION FORMContact Details - Young Person making this applicationContact NameHackney YouthOpportunity FundOrganisation / Youth GroupAddressPostcodeEmailMobile/TelephoneFaxAdult Contact - Project sponsor from organisation supporting your groupContact NameOrganisation / Youth GroupAddressPostcodeEmailMobile/TelephoneAPPLICATION FORM 1FaxCharity/Company Ltd Number

Activity addressIs your project/activity going to take place at a different address?If yes, what is the address and post code?Contact NameOrganisation / VenueAddressPostcodeEmailMobile/TelephoneFaxSECTION 1: About your group1. What is the name of your group?2. Tell us about your group. What sort of group is it? (for example,are you a group from a youth club, a group of school friends, etc?)3. If you are linked to a larger group, please tell us the name.APPLICATION FORM 2

4. How many of you are making this application?Please list the names of the young people who are making this application.You can attach an additional sheet if requiredName AGE MALE/FEMALEAPPLICATION FORM 3You will be asked to complete a full monitoring information form in section 6 of this form. This information isvery important so please complete each section. If you have any questions, please contact us.

SECTION 2 – About your projectPlease tell us about your project in this section. You can use notes from discussion meetings to tell us how your ideacame about. Attach extra sheet if you need to, but try and keep it to a minimum of 2 A4 pages.Make sure you have read the information in the guidance notes before you fi ll in this part.1. What is the name of your project?2. Tell us about your project idea (what will you actually do?)Please attach a project plan if you have completed one.3. Do you have a supporting statement from your project sponsorStatement from the member of staff or adult who will be supporting you to manage this project and will beaccountable for the return of financial and monitoring data. This statement should be brief but must confirm thatthey are backing your idea and will help you achieve your goals.Yes NO If yes, please attach a separate piece of paper4. Tell us how your project supports one or more of the Every ChildMatters five outcomes for young people?Staying safe, enjoy and achieve, be healthy, make a positive contribution and achieve economic well begin.APPLICATION FORM 45. How long will your project/activity last?Start DateEnd Date

SECTION 3: Benefits of your project.Please tell us about Individual progression young people will benefi t from by taking part in the project.1. How many young people taking part in the project will learn new skillsor knowledge (Recorded Outcomes)?Young people organising the projectYoung people who take part in the activitiesAnyone outside the project2. How many young people taking part in the project will get Accreditation?Young people organising the projectYoung people who take part in the activitiesAnyone outside the project3. What types of accreditation will they be awarded?.Award MALE FEMALEDuke of Edinburgh AwardAsDANAQAV AwardOpen College NetworkOtherYouth Achievement AwardFirst AidNVQFC coaching badgeFA Level OneOther4. Will young people get 6 hours or more of skills training? If yes how many?APPLICATION FORM 5Young people organising the projectYoung people who take part in the activitiesAnyone outside the projectPlease visit www.nya.org.uk for more information about Recorded Outcomes and Accreditations

5. Tell us how you are going to reach and encourage young people fromdifferent ethnic and cultural backgrounds in the borough to take part?6. How will you reach and encourage disadvantaged young people totake part, e.g. looked-after young people, young care leavers, youngrefugees, young offenders, travellers, disabled young people, younglesbians and gay men, young parents and young carers, young peoplenot in education, employment and training (NEET)?APPLICATION FORM 6

SECTION 4 – How are you going to spend the money?Please use the table below to list all the items that you need funding for.Cost of ProjectAmountStaffing: (include rate* and number of hours* days) £Publicity material £Accommodation £Venue £Transport £Materials/Equipment £Food/drink £Administration £Travel Insurance £Other £Other £Other £Other £Other £Other £Other £Total £What is the total cost of the project? £Do you have any other funding? If yes, please tell us the amount, and £who its from_________________________________________How much YOF are you asking for? £Is this your first application for YOF If no, how many awards have youreceived to date?NO:What other funds have you applied to and waiting to hear from?How much have you asked for? £APPLICATION FORM 7We will contact your support organisation before we agree any funding. You must keep all receipts and invoices foreverything spent otherwise you will be required to return money not accounted for.

SECTION 5: Monitoring and EvaluationThe aim of this section is for you to tell us how you are going to keep your project/activity on track, and how you willtell us about what you achieved at the end of the project/activity.At the end of your project we will ask you to produce a report to show what was achieved. This can be in differentformats – individual evaluation, recorded interviews with young people, audio tapes or a written report. We willask you to share the success of your project with other people, for example through the Young People’s Magazine,newsletters and press releases.1. Tell us how you will keep a record of how well the project is going?(e.g. video, audio tape or written record)APPLICATION FORM 8

SECTION 6: Information about your group.For the purpose of monitoring funding we are required to collect information about members of your group which issolely for equal opportunities monitoring.1. How many young people are there in your group?2. What is the age AND GENDER OF EACH YOUNG PERSON?13 Male Female 14 Male Female15 Male Female 16 Male Female17 Male Female 18 Male Female19 Male Female Over 19 Male FemaleTotal MaleTotal Female3. How many young people are:White British White Irish Kurdish Turkish JewishWhite other Black British African Caribbean Black otherAsian British Bangladeshi Chinese Indian PakistaniVietnamese Asian other OtherDual heritage (please specify)4. How many young people in your group have (or self determine) specialneeds or a disability?Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical ormental impairment which has a sustained and long-term adverse effect on his/her ability to carry out normal dayto day activities. Since 2005, people with HIV, cancer and multiple sclerosis (MS) are covered by the DDA.Male Yes Male No Total Male Female Yes Female No Total FemaleAPPLICATION FORM 95. How many young people in your group would define themselves as:Heterosexual Lesbian/Gay/Bisexual/Transgender LGBT Prefer not to sayThis information will not affect your application, and is treated in accordance with the Data Protection Act 1998.

4. How many young people in your group are in education, employment or training?SchoolMale female TotalPupil Referral UnitCollege/UniversityTraining CentreApprenticeFull-time employmentPart-time employmentNot in Education,Employment orTraining (NEET)Other please state:APPLICATION FORM 10This information will not affect your application, and is treated in accordance with the Data Protection Act 1998.

Thank you for completing this section of the form.We have read the guidance note, and we all agree that the information wehave given in this application is correct and true.NameSigned (young person)DateNameSigned (young person)DateNameSigned (Adult contact)DateThe young person and adult contact is from your support organisation, and should be the same contact as youentered on the first page of the application formWhat happens now?•Check that you have completed all sections of the form•Keep a copy of your application.•Send your application by post to:Youth Opportunity Fund Application,Hackney Youth Service, 205 Morning Lane, Hackney London E9 6JXor Email YOF@hackney.gov.ukAdministration Details (Office Use Only)APPLICATION FORM 11Application NumberDate ReceivedDate ApprovedAmount GrantedDate BACS/Cheque SentNot Approved – ReasonYOF/PJ35263