Sustainable AmbITion Application Form

Please read the Make:IT:Happen Fund Guidelines and the Sustainable AmbITion Fund Section before completing this form. If you would like assistance with the form or guidelines, please contact, ela@culturesparks.com, 0141 248 6864. Organisation Name Contact (must be CEO or equivalent senior staff member) Position in organisation Address Telephone Email Social enterprise company registration or charity number What do you want to do? - publishable summary (50 words)

Postcode:

Why do you want to do it? (200 words – demonstrate research with evidence) How does the proposed project fit within the organisation’s core mission? (100 words) What lowering of carbon outputs do you hope to achieve? (200 words – be clear about the area of work: audience engagement, business operations and/or working practices) What is your project plan? (250 words – include specifics on who (including any collaboration partners), how, what & when) How will you know if it is successful? (200 words – plan for measuring impact) What are the potential risks and how will you mitigate them? (150 words) How have you engaged with AmbITion Scotland, NESTA or SYNC in the past? (50 words) Estimate project duration: Estimated project start date: Estimated project end date:

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Please set out your budget. (in £)

Income Own contribution MITH investment requested Other earned income Total Partnership investment:

Total

Other income Total project income Expenditure Project costs Other costs Total project expenditure Total project surplus/(deficit) Total

Detailed breakdown of income sources If you have entered a figure for Other Earned Income, Partnership Investment or Other Income above please attach a full breakdown of the amounts and sources of income.

Staff Resource Please can you estimate the average amount of in-kind staff time you anticipate committing to this project. (please complete either one or other)
Enter no’ of hrs in

Hours per week for Days per month for

Enter No’

weeksdays months

boxno of hours
Enter no’ of days in

Enter No’

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Statement of Acceptance of Terms and Conditions PLEASE STATE THE NAME OF THE PERSON WHO HAS COMPLETED THE FORM. THIS PERSON MUST BE AN AUTHORISED SIGNATORY OF THE COMPANY OR ORGANISATION APPLYING. I confirm that the information in this application submission including the supporting documents is true and correct and I acknowledge that it is my responsibility to inform you immediately of any changes which could affect the interpretation or context of the application, and I confirm I will undertake to do this. I acknowledge that AmbITion Scotland will endeavour to keep all information provided securely, but in terms of the Freedom of Information (Scotland) Act 2002, may be required to disclose certain information under the Act. Where I stipulate at the time of providing information to AmbITion Scotland that I believe the information should be considered exempt from disclosure under that Act, and a request to AmbITion Scotland is subsequently made for disclosure of same or all of that information, AmbITion Scotland will endeavour to discuss such disclosure with me prior to making its decision. I do, however, accept and acknowledge that the ultimate decision on disclosure rests solely with AmbITion Scotland regardless of any prior statements or requests I have issued. USE OF PERSONAL DATA I acknowledge that: (i) Information supplied by me in support of this application will be processed by Glasgow Grows Audiences Ltd (trading as Culture Sparks) in order to evaluate and assess this application. That information will also be processed by Glasgow Grows Audiences Ltd (trading as Culture Sparks) and reported to Creative Scotland for accounting, statistical and monitoring purposes. (ii) My name, address and contact details may be held on Glasgow Grows Audiences Ltd’s (trading as Culture Sparks) database. It will use this information to send details of AmbITion Scotland learning resources, events and networking activities. I acknowledge that I can opt out of receiving that information by writing to Glasgow Grows Audiences Ltd (trading as Culture Sparks). I confirm that all contributions from the company or my own personal resources stated in this application budget are correct and that I have the authorisation to allocate the sums stated and I am responsible for ensuring that adequate resources will remain available to meet these requirements. In the event of any changes to the sums indicated I will provide a signed letter of confirmation. I acknowledge that AmbITion Scotland is obliged to comply with Money Laundering Regulations 2007 and the Proceeds of Crime Act 2002 and I will, if requested, provide ID verification from any investor or myself, where appropriate, to meet compliance requirements. AmbITion Scotland is not under any obligation to release funds until such time as the funding agreement is signed off. I acknowledge that once AmbITion Scotland has confirmed my application is successful, AmbITion Scotland has the right to publicise it on the AmbITion Scotland website and through other AmbITion Scotland information channels. Glasgow Grows Audiences Ltd (trading as Culture Sparks) has been appointed to deliver the National Lottery funded 'AmbITion Scotland' programme on behalf of Creative Scotland. The 'Make:IT:Happen Fund' forms part of that programme. Any award of funding from the 'Make:IT:Happen Fund' is conditional on the funding recipient entering into a funding agreement with Glasgow Grows Audiences Ltd (trading as Culture Sparks) which includes, among other

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things, terms which correspond to the conditions set by Creative Scotland. For example, those terms will require the funding recipient to cover all costs incurred by Glasgow Grows Audiences Ltd (trading as Culture Sparks) which relate to any claims against Glasgow Grows Audiences Ltd (trading as Culture Sparks) by Creative Scotland caused by the funding recipient's breach of the funding agreement. Those terms will also require the funding recipient to acknowledge (in a prescribed manner) the Lottery funding that made the project possible. I acknowledge that, if my application is successful, payment of funds will be conditional on entering into a funding agreement with Glasgow Grows Audiences Ltd (trading as Culture Sparks) in accordance with the foregoing. I confirm that I will not make any public statements (or allow others to do so on my behalf) regarding AmbITion Scotland’s Offer of Investment until such time as AmbITion Scotland has authorised and approved the form and content of any public statement. I confirm that I have the power to accept the award under the conditions set out in the AmbITion Scotland Make:IT:Happen Fund Guidelines and in this Application Form. I acknowledge that it is recommended that I read the AmbITion Scotland Make:IT:Happen Fund Guidelines, this Application Form, the outline statement of Terms and Conditions and guidelines for Creative Scotland Lottery investment before submitting this application. I acknowledge that I may contact Glasgow Grows Audiences Ltd (trading as Culture Sparks) if I require copies of these documents or further information about application requirements. I acknowledge that the terms and conditions of this application and any other information supplied and discussed regarding this application, the assessment and decision making process, or in connection with this transaction as a whole (“the Confidential Information”) is and shall remain strictly confidential. I confirm that I shall not disclose to any third party or make public the Confidential Information without AmbITion Scotland’s prior written approval. I confirm acceptance of the above statement of the Terms and Conditions for all related documents. …………………………………………… Name of Authorised Person …………………………………………… Position of Authorised Person …………………………………………… Date Please complete, sign and send two signed copies of the application form to: The AmbITion Scotland Make:IT:Happen Fund, c/o Culture Sparks Suite 1/1 6 Dixon Street Glasgow G1 4AX

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