Application for a charitable project/equipment

Contact name (required)

Please provide your email address and contact number (required)

What division are you in? -planned care, unplanned care, cancer, research, corporate, women and children? (required)

What would you like funding for? (required)

How much charity funding are you requesting in total? (please gather official quotes or estimate the total spend) (required)

Who is your manager and have they agreed this application? (required)

Have you gained permission to apply for charitable funds from your Divisonal Director? (required)

Are you aware of any funds that have been donated/raised in support of your idea? (required)

The following questions are used to assess whether or not the project is supported, please be as clear and precise as possible, using numbers and detailed descriptions. Unfortunately forms with vague details will be sent back, which will increase the time taken to gain authorisation. Thank you

How many patients or staff will benefit? (required)

How long will they benefit for? (required)

How many relatives or family members will benefit? (required)

Are you replacing equipment purchased by the Trust? (required)

What is your estimated project start date? - eg. when do you hope to receive the equipment or to have commenced the service? (required)

What difference will this project make? (required)

Please explain how it is above and beyond the obligation of the NHS (required)

If this project includes hiring a member of staff or this project requires maintenance beyond the funding granted, please explain how this will be continually funded?

Is your project consistent with Trust Strategy? (required)

If funding is approved, which staff member will be responsible for purchasing the items/equipment or initiating the project? *please note the charity doesn’t purchase items and will issue charity cost code for oracle/iproc

If your project requires a change of use or refurbishment to a space, do you have approval from SUG? (required)

Please tick the statements that are true

I have ensured appropriate electrical points(e.g. additional outlets, 3 phase etc.) Water, Gases, Building alterations, brackets/fixings processes and labour costs and have spoken estatesI have covered any special decontamination or sterilisation procedures?I have considered provision of maintenance and support, including service contracts and documentation manuals?I have considered any special handling procedures. (clothing, tools etc)? I am following Trust SFI’sIT equipment been authorised by the Trust’s IT department to ensure that it is compatible with Trust systemsIf my project is for staff, I have ensured it benefits staff at all sites

Do you have any comments or assurances that can be provided against the above list?

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