Herts Healthy Homes 2014/ 15

LOCAL INITIATIVES PROJECT FUNDING APPLICATION

We welcome applications from any community or voluntary sector
organisation based in Hertfordshire who can contribute to achieving one or
more of the Herts Healthy Homes project outcomes. Applications need to be
completed and returned by 28th November 2014.
Please read carefully the accompanying guidance to ensure your project
contributes to achieving the Herts Healthy Homes project outcomes.
1. Applicant Details
Organisation
Contact Name
Address
Phone/Mobile Number
Email address of contact
2. Proposal Details
Proposed Project Title:
3. Proposal Summary Describe the proposal (in no more than 100 words).

4. Project Aims: Describe how the proposal will address the key themes of
Herts Healthy Homes (HHH) and support the main project. This must include
how you will work in partnership with other Community Groups to deliver. Please
bullet point key themes to be achieved. (no more than 200 words)

5. Please give a brief summary of your project plan, including the timescales
when things will be delivered. Projects must be completed by 30 August 2015
and evaluation submitted by 30 September 2015.

6. Targeting: From the list below, please

select the keywords that best describe the
beneficiaries of the proposal and the
approximate number of beneficiaries to be
targeted
Beneficiaries
Over 75 years old
Frail
Pre-existing cardiovascular or respiratory illnesses and
other chronic medical conditions
Severe mental illness
Dementia
Learning difficulties
Arthritis, limited mobility or otherwise at risk of falls
Young children
Living in deprived circumstances
Living in homes with mould
Fuel poor (needing to spend 10% or more of household
income on heating home)
Elderly people living on their own
Homeless or people sleeping rough
BME Community
Rurally isolated
Carers
Other (please state)

Tick

Approx No.

7. Evaluation Describe how you will evaluate the success of the proposed
project (in no more than 200 words).
8. Project Costs (provide brief details of the costs of the
project, separately identifying any communications and
consultancy/management fees)
Details
1.

Costs

2.
3.
4.
TOTAL costs

9. Supporting Statement Describe how you will evaluate the success of the
proposed project (in no more than 300 words).

When will the project start and

finish?

Start: MM/YY
Finish: MM/YY

11. Declaration:
The funds requested in this application will support a new project, a project
where no funding has been allocated or an extension of an existing project. The
funding will not be used to replace existing funding.
Signed:

Name:
Title:
Organisation:
Date:

Email to: daisy.sanghera@hertfordshire.gov.uk

Or by post to:
Daisy Sanghera, Commissioning Manager, Community Wellbeing Team, Health & Community Services,
Hertfordshire County Council, Postal Point SFAR 202, Farnham House, Six Hills Way, Stevenage. SG1
2FQ

Applications need to be completed and returned by 28th November 2014