Glendalough and WMNP Masterplan Public Consultation

Address

Number of Voluntary Workers
Number of Paid Workers
How many members are there?
Is membership open?

Yes
No
Details of membership fees
What are the aims, objectives and ethos of your group?
What are the activities of your group?
What is the activity or action for which you are seeking a grant?
How will the activity or action be managed?
Why is there a need for this activity or action? Please provide support/proof of need or consultation carried out?
Who will benefit from this activity?

Governance Code:
Has your group signed up to the Governance Code?

Yes
No
In the process of signing up?

Yes
No
Is your group a member of the Public Participation Network?

Yes
No
Name of your Group Bank/Post Office or Credit Union Account: (This is the name that appears on your statement)
Outline the estimated cost of the activity or action. €
Amount sought from Wicklow County Council. €
If the amount you are requesting is not the total cost of the proposed activity or action, please advise from where the balance of funds is coming
Have you applied for or received funding from any other source in the last year?

Yes
No
If yes, please give details.

PLEASE INCLUDE THE FOLLOWING WITH YOUR APPLICATION FORM APPLICATIONS WILL NOT BE CONSIDERED IF THESE DOCUMENTS ARE NOT SUPPLIED.
Copy of current Bank, Credit Union or An Post statement and a copy of group constitution.
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DECLARATION:
I declare that all the information given in this form is true and complete to the best of my knowledge and belief. I acknowledge that any funds awarded must be used for the purpose stated. I also accept as a condition of the grant scheme: • That it involves no commitment to any other grants from Wicklow County Council in the future. • Wicklow County Council reserve the right to request further information, if required. • Wicklow County Council will undertake to review the scheme from time to time and as a result may make any changes necessary without any prior notice and at the Council’s discretion. • That Wicklow County Council hold no responsibility for the project and that the project must meet with all Planning and Health and Safety Regulations. • To have the project monitored by Wicklow County Council or by its agents, to allow access to its premises and records, as necessary for that purpose. • To provide details of the grant spent in the Evaluation Form provided by the 31st December, 2021 • That grant allocation must be used for the project approved and grant monies unspent within the 12 month period must be returned.
Chairperson

First Name
Last Name

Living in Wicklow