Memory Activity and Support Groups Grant – Feedback Report Memory Activity & Support Groups Grant Feedback Report Step 1 of 7 14% When you applied for the Memory Activity and Support Groups Grant, you signed an agreement on your application form that you would complete this Feedback Report and return it to us together with evidence of the spend of this grant e.g. copy receipts, invoices, etc, within the timeframe specified on your application form. In order to understand how the activity your group took part in has helped, we would like to ask you a few questions. We are passionate about assisting people with dementia so all feedback is valuable and may be used to secure further funding for this particular need. Please note, this report is essential and will be used to report back to Cornwall Council and NHS Kernow. Failure to submit a feedback report with corresponding receipts may result in us not being able to consider your group for any future funding. If you need any help completing this form, please call us on 01872 243535 or email grants@cornwallrcc.org.uk Save and Continue Feature Please note, this application form can be saved partway through. Please click the Save and Continue Later link at the bottom of any page. You will be asked to supply your email address and you will be emailed a link to your application form so that you can continue to complete it at a later date. All questions marked with an asterix* require an answer and cannot be skipped. You will need to complete all questions with an asterix* before moving onto the next page. Please do not give any specific medical information in this form, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information. Application no (if you know it) Your name* Group name* Your address, including postcode*Daytime telephone number* Email*The majority of correspondence will be carried out electronically About the grant fundingAre you a new group that has just received the £500 start-up funds?* Yes No If yes, are you now requesting further funds?* Yes No How much are you now requesting?* When did you receive the grant? Month/year What was the activity or item that this grant funded?*How many people attend your group regularly?* Did you do anything different to what was agreed on your application form?* Yes No If so, please tell us what* Grant SpendTotal amount you received* What has the grant been spent on?*Please give us a breakdown of what your grant was spent on, below, also indicating if receipts are being submitted (if not, please explain why). You can upload receipts below or email receipts to grants@cornwallrcc.org.uk or post to Grants, CRCC, 2 Princes Street, Truro TR1 2ES To add more rows, click on the + symbol at the end of each row.Item/ activityActual Expenditure (£)Receipts enclosed: yes or no Please upload your receipts here, if you wish Drop files here or Select files Max. file size: 64 MB. How the grant has helpedPlease summarise how the activity or item benefited you as a carer*Please provide full details of how the grant has benefitted group members. Please tell us how it has helped their health and wellbeing, what difference this has made to them, e.g. their quality of life has improved, they are better able to cope with theirdementia, they are more supported, less isolated, etc Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information. Please include anonymous feedback/quotes from group members where available Please tick the relevant boxes to tell us how the grant has benefitted your groupImproved quality of life for group members* Very much so A little Neutral Not much Not at all Reduced the need for additional support* Very much so A little Neutral Not much Not at all If you feel this grant programme could be improved, please specify how?Members' Stories We would love to hear more about the impact that grant has had on individuals with dementia. The more detail a person is able to give us, the better. If you would be kind enough to tell us more, we can use this information (anonymously) to show Cornwall Council and NHS Kernow how vital this grant is in supporting people. . Please note, you do not have to complete this section.Please could you tell us a little bit about the impact that having dementia has had on your general health and wellbeing.Please do not give any specific medical information, e.g. a health diagnosis as, under EU General Data Protection Regulations (2018) we are not permitted to hold this information.How does being part of this group support you with your health and wellbeing? What difference has it made to you?Any other commentsThank you!