Name of individual or organisation applying for the grant: ______________________________________________________

Contact address: ________________________________________

Tel. no(s):_________________ e-mail: ______________________

1) What are the aims of your organisation and/or project?

Is your organisation a registered charity? Yes/No

If yes, please give registered Charity No.: __________________________________

Does your organisation have a constitution, please enclose along with names and addresses of:- Chair:____________________________________________________________________
Secretary:_________________________________________________________________
Treasurer: ________________________________________________________________

2a) Please give details of how the grant would be spent and include costings:

2b) What is the total sum applied for? £_______

3a) What is the timescale for the scheme? _________________________________

3b) Is this a new initiative, or has the scheme been run before?

4) Hackney Safer Cities Project is concerned to reduce crime and the fear of crime together with improving community life. How do you envisage this project contributing to these ends?

5) How will you monitor (e.g. record the number of young people contacted, homes secured, quantity of graffiti removed) and evaluate (provide evidence that the scheme has or has not achieved what it set out to do) the effectiveness of your scheme in reducing and preventing crime, reducing the fear of crime and improving community life? Monitoring: Evaluating:

7) Your scheme will only be considered if it is operated within the spirit of Hackney's Equal Opportunities Statement, a copy of which you should obtain. Your signature below will be taken as a sign that you agree to abide by the letter and spirit of the statement in the implementation of this project.

8) To which organisation should the cheque be made payable?

____________________________________________________________________________

Signed: ________________________________________ Date: __________________

Treasurer: Barbara McFarlane Clissold Mansion Clissold Park London N16.
e-mail: mcf@dircon.co.uk