This form will take approximately 60 minutes to complete. Please allow yourself enough time to complete this form in one session as there is not an option to save and come back to it later. The questions marked with an asterisk (*) are mandatory and require an answer. You do not have to answer all of the other questions, but it would help us if you do. Details of your organisation Name of organisation * Enter the name of your organisation. Charity or company registration number * Enter your charity or company registration number. Organisation address House name/number Enter the address name or number. This could a flat, house or building name or number. Address line 1 Enter the first line of the address. This could be the street name. Address line 2 Enter the second line of the address if you need to. This could be the village name. Town/city Enter the town or city of the postal address. Postcode Enter the postcode, with or without spaces. Contact details Contact full name Enter the contact's first and last name. Email address Enter an email address where we can write to you. Phone number Enter a daytime phone number that we can ring you on. This can be a mobile or land line number. Alternative phone number Enter another phone number we can reach you on. This can be a mobile or land line number. About your service Which of the following best describes your organisation? Select all that apply for your organisation. Dial-a-Ride Group Hire Service Social Car Scheme Members/Service Users Transport Scheme Shopmobility Co-ordinated Transport Scheme Travel Companions Which of the following categories are eligible for your organisation’s transport services? Select all that apply for your organisation. People with a physical or sensory disability (including frailty) People with a learning difficulty or mental health problem Over retirement age Under 21 Members of a voluntary organisation/association, religious group, school or college People living in a rural area with little or no public transport services Area(s) covered by your organisation Enter details of villages, parishes, towns or districts that your organisation covers. Operating times for an average week Enter details of your organisation's opening times as accurately as possible. Do not specify ‘at anytime’ unless the service is regularly operated for seven days each week and 24 hours each day. How many individual groups does your organisation provide transport for? Enter group details based on an average week. How many individual passengers does your organisation provide transport for? Enter passenger details based on an average week. Vehicles your organisation owns or uses as part of the service it provides Enter details of all vehicles including minibuses (state if wheelchair accessible), volunteer cars, wheelchairs and scooters. Do you use vehicles belonging to other organisations? Select 'Yes' or 'No' as your answer. Yes No Provide details of which organisations vehicles you use Enter details of vehicles below. Does your organisation have a paid transport manager/coordinator? Select 'Yes' or 'No' as your answer. (For the purposes of this form, this is any paid member of staff who takes full responsibility for the scheme). Yes No How many full time, paid staff does your organisation have? Enter full time details below. How many part time paid staff does your organisation have? Enter part time details below. How many volunteer staff does your organisation have? Enter details below. Do you work together with other local groups in your area? Select 'Yes' or 'No' as your answer. Yes No Provide details of other local groups you work with Enter details below of local groups. Financial information Details of your current sources of funding Enter details of funding, including amounts where possible. Details of any reserves that your organisation holds Enter details of reserves, including the amount and the reason for holding them. What is the total amount you are seeking from the County Council? Enter amount below. How will the grant be spent? Enter details below. Upload your most recent income and expenditure account Attach supporting documents. Upload your most recent balance sheet Attach supporting documents. Upload passenger numbers from the last 12 months Attach supporting documents. Upload your planned expenditure for the coming year Attach supporting documents. Supporting documents Attach any other documents to support your application. Disclaimer This authority is under a duty to protect the public funds it administers, and to this end may use the information you have provided on this form for the prevention and detection of fraud. It may also share this information with other bodies responsible for auditing or administering public funds for these purposes. Your full name Enter your full name to show you agree to the above statement. To send your form to us press the 'Submit' button once. After a few moments you will see our 'Thank you' page. If you do not see the 'Thank you' page we will not have received your form.