Clubs & Societies Grant Application Form
For Academic Year: 2011 / 2012
Club / Society Name:
____________________________________________
Committee Details Name
Name of Club / Society:
____________________________________________________
Club / Society E-mail Address:
____________________________________________________
Website Address:
____________________________________________________
Committee Members Title
Name
Student Number
Contact Numbers
Chair Secretary Treasurer PRO Equipment Officer Safety Officer
Honorary President
Club / Society Honorary President:____________________________________________________ E-mail Address:
____________________________________________________
Telephone Number(s):
____________________________________________________
Note: The Honorary President of each Club or Society must be a Member of NUIM Staff
1
Affiliation Please list all organisations the Club / Society is affiliated with. Governing Body
Is Affiliation Compulsory?
Affiliation Fee
1 2 3 4 5
Insurance Are the Club / Society members insured by the Governing Body above?
YES / NO
If Yes, please attach details of the cover provided. If No, please indicate if the Club / Society takes out any insurance cover in addition to NUIM insurance. YES / NO (Attach details of the cover provided)
Banking Details Account Name
Account Number & Sort Code
Balance at date of application
Signatories
Note: You must have at least two signatories, one of which must be the Club / Society Treasurer Please attach a copy of your most current bank statement. Applications that do not have a statement will not be considered.
2
Membership Number of paid up members:
____________
Total income from Members:
____________
Note:
Please ensure that you submit your membership lists with the grant application form. A copy of the bank lodgement of membership fees must be submitted with the grant application form.
Sponsorship Please outline below only sponsorship that has been secured for the academic year. Company Name
Value of Sponsorship
Club / Society’s Obligation to Sponsors, e.g. name on programme / jersey, etc
1 2 3 4 5 6 7
Safety Arrangements Please provide details of any safety policies/procedures the Society currently operates eg. Safety Statement/Risk Assessment/Emergency Plans/ Equipment Maintenance or Inspect Schedules etc.
3
Planned expenditure: All Clubs and Societies are asked to outline their planned expenditure for the coming year. A breakdown of your planned expenditure is required i.e. cost for transport, accommodation etc for each event. Date
Details Any outstanding debt
Cost
Total Planned Expenditure:
â‚Ź
4
Planned Income: All Clubs and Societies are asked to outline their planned income for the year. A breakdown of your planned income is required i.e. where the money is coming from for each of your events Date
Details
Cost
Currently in bank Membership from Fairs Day
Total Planned Income:
â‚Ź
5
Case Submission: This is your chance to tell the Capitation Committee about your Club/Society. You should outline any achievements in your Club/Society in the previous year and what you hope to achieve in the coming year.
6
Capital Assets List Please list all assets that are valued at â‚Ź10 or more, which are held by your Club / Society.
Asset
Place of Storage
Value
Age
Insured?
1 2 3 4 5 6 7 8 9 10
Note: If equipment is insured a copy of the policy must be provided.
7
Application for the Purchase of Capital Equipment List in order of priority. Equipment
Purpose
Number Required
Cost per Unit
Total Cost
1 2 3 4 5 6 7 8 9 10
8
Summary Item
Cost
Total Income Total Expenditure Difference Capital
Total Funding Applied For
Chairperson’s Signature:
____________________________________
Treasurer’s Signature:
____________________________________
Date:
____________________________________
Please note: Capitation Applications forms must be handed into the Students Union office. Please ensure a recent bank statement and full members list is attached to your application.
9
Access to Clubs & Society’s Room In order to be able to access the Clubs & Society’s Office in the Student Centre, you need to provide us with the following information. Please note access to the Clubs & Society’s Office is restricted to Committee Members only. Name
Course
Year
Student Number
Bar Code Number
10