Section 1: About your Church

Church name

Location / Town:

Denomination:

Local Authority:

Diocese / Area:

Postcode:

When was the church built (state century if earlier than 1800)?:

Listing Grade: I II UNL 

Conservation Area: Yes No 

Other statutory designation / protection:

Describe your church and its significance in the community
(maximum 500 characters please)500

Section 2: Church Usage

Average Sunday attendance (all services)

Population of parish or catchment area

Average number of religious services a month

For what purposes other than worship is the church used?

Is the church open or closed in daylight hours? : Open Closed 

Briefly describe arrangements for access if closed

Section 3: Upkeep of the church

Date of last Quinquennial Inspection or equivalent building survey

Description and cost of significant work (other than maintenance) in the last five years, and how this was funded
(maximum 50 words please)250

Do you have a schedule for routine maintenance?: Yes No 

Section 4: Contact Details

Details of the person who will act as contact point with us

Name

Address

Telephone

Email

Section 5: Your repair project

What work would our grant be used to help pay for?

If these repairs are part of a wider project, briefly describe the wider project

What approvals do you have already?
Please do not send copies of approval documents unless requested to do so

What approvals do you still need to obtain?

What is the earliest date work could start?

Details of the person who will supervise the project on behalf of the church (eg architect)

Name

Address

Telephone

Email

Please state any relevant qualifications of this person relevant to supervision of the project

Section 6: Finance

Costs

Repair costs (£)

Contingencies - if any (£)

Professional fees (£)

VAT (£)

Total (£)

Funds

Please tell us how you became aware of NHCT as a potential source of funds

State briefly how you intend to pay for the work

Secured or pledged

From existing church funds (£)

Heritage Lottery Fund (£)

Other - please state (£)

Applied for or anticipated

LPW (VAT) grant (£)

Local fundraising (£)

NHCT (£)

Other - please state (£)

Total (£)

Is any of the work covered by an insurance claim?: Yes No 

If total funds are less than the total costs, how do you propose to make up the difference? :

Are further repairs needed after completion of this project? : Yes No 

If yes, and you have an estimate of cost, please state (£) :

How much is your church asked to contribute to central church funds each year (£) :

Section 7: Further information required

Please submit the following information with this application (tick boxes to confirm) or send by email to secretary@northumbriahct.org.uk.

• Copy of the listing description or other heritage description if relevant
• One or two external and one or two internal colour photos of the church as a whole, plus two to four photos showing more details of the proposed repairs. You can also send digital jpeg photos by email or enclose digital photos on a CD with a postal application.
• Audited/examined accounts covering the last two completed financial years. Please include all those relevant to the church or parish, such as associated trusts and Friends' organisations, even if the funds are not available for repairs.
  • Audited Accounts:
    
  • Examined Accounts:
    
• Summary of the most recent report of a Quinquennial Inspection or equivalent building survey and extracts relevant to the repairs - the complete report to be provided if requested

In addition please send us the following information if available and if feasible to do so.

• Statement of Significance and Need
  
• Specification of works
  
• Summary of tenders
  
• Responses of other funding bodies to your requests for funding
• Copies of relevant reports or written advice about the proposed work

Section 8: DECLARATION

To be signed by the priest or minister responsible for the church, or some other person with full authority to sign on behalf of the relevant governing body.

1. I am authorised to apply for a grant to the Northumbria Historic Churches Trust (NHCT) on behalf of the priest or minister and the relevant governing body of the church
2. The information given in this application is accurate and reliable, to the best of my knowledge
3. I have read and understood the Guidance Notes and the Standard Conditions of Offer
4. Any photos or images provided by the applicant to NHCT may be freely used by NHCT for publicity purposes.



Name

Post Held

Signature


Date