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Application Form

1.  GROUP DETAILS

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If you are applying on behalf of an organisation, please add the address of the organisation otherwise add your address

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6.  

Does your group have 2 or more members?

* required
7.  

Are you a Constituted or a Non-Constituted Group?

* required
If you tick ‘Constituted’, your organisation must have a constitution/governing document, financial controls, relevant policies and insurance in place. If you tick ‘Non-Constituted’ you will be required to obtain a sponsor. See guidance notes for more information.
8.  

Are the group members (i.e. those applying)  over 18?

* required
If you tick no and the group members are under 18, please ask a supporting adult to complete the application form with you.

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2.  PROJECT DETAILS

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Give your project a short name:
11.  

Will your project benefit people who live within the Belfast City Council area?

12.  

Please specify which area your project will take place:

* required
13.  

Which elements of the Take 5 steps to wellbeing is your project going to focus on? (tick all that apply)

14.  

Please note that all projects will be expected to promote the importance of all Take 5 steps to wellbeing . 

Will your group need any assistance to help you promote the Take 5 message, for example leaflets, posters or other support?

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16.  

Please confirm you can deliver your project by October 2025

* required
17.  

Please confirm that you will attend a celebration event in November 2025:

* required

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For example: young people, older people, anyone at risk of loneliness etc.
Please provide a list of expenditure items and the amount of money required for each item as indicated in the image above.

3.  SPONSOR DETAILS

If your group does not have a governing document or your group contact person is under 18, this section needs to be completed by the Sponsor Organisation. If you need help connecting with a Sponsor Organisation, please get in touch with one of the local area coordinators listed at the Help and Advice section on the main page.

21.  

Does your application require a sponsor organisation? 


Remember if you are under 18 or are an unconstituted group you will need an authorised organisation to sponsor your application.  

* required

4.  DECLARATION

By submitting your entry you are agreeing to the following statements:

a. You have been authorised by your organisation/group to submit this entry.

b. All information you have provided in the application is accurate and complete and you will notify us of any changes.

c. You or your sponsor organisation will provide a copy of your or your sponsors constitution/ governing document, financial controls, relevant policies and insurance upon request.

d. The project will benefit people who live within the Belfast City Council area.

e. Any information supplied will be used during the assessment and life of the project (if successful) to administer and evaluate it. We may give copies of all or some of this information to individuals and organisations we consult with when assessing the bids or who provide support with administration, monitoring or evaluation of the programme. See Privacy Notice on the next page.

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Name of lead applicant

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Contact number of lead applicant
Email address of lead applicant
26.  

Are you aged 16 and over?

* required

Returning your application:

Before submitting your online application, please take a screen shot of your answers.  Or email flynnp@belfastcity.gov.uk to request a copy of your submission. Once you are ready to submit your online application, please hit the Submit button at the bottom of this form.  

Applications must be submitted before 4.00pm on Friday 10 January 2025.

Privacy Notice

Belfast City Council is the data controller under the UK General Data Protection Regulation (UK GDPR) for the personal data it gathers for the purpose of administering and managing your application to the Take 5 steps to wellbeing - your voice, your choice.

As lead representative of your Group, you are consensually providing your personal data to the Council whose lawful basis for processing is for the performance of a public task.

The personal data may be shared with Council staff involved in the administration and management of your application and where necessary with relevant internal Council departments for the purpose of assessing your application, administering payment, delivering the services relative to your application and offering any additional support relevant to your proposal.

Your personal data may be shared with necessary external organisations who are working in partnership with the Council to deliver this programme. Your personal data will not be shared or disclosed to any other organisation without your consent, unless the law permits or places an obligation on the Council to do so. The personal data is held and stored by the Council in a safe and secure manner and in compliance with UK data protection legislation and will be disposed of in line with the Council’s Records Retention and Disposal Schedule.

All information provided on this form may be further processed for audit purposes or as necessary to prevent duplicate or fraudulent applications.

If you have any queries regarding the processing of your personal data please contact the Belfast Health Development Unit at mlbt@bhdu.org 

If you wish to contact the Council’s Data Protection Officer, please write to Belfast City Council, City Hall Belfast, BT1 5GS or send an email to dataprotection@belfastcity.gov.uk