Membership Application Form

The information given on this formwill be stored electronically on the 3VA database. Information will not be given to third parties unless you have given your permission.

Note: If completing this form electronically double click on check boxes, select ‘checked’ and click ‘OK’

1. Your contact information:

Name of Organisation:
Name of Main Contact:
Address (Organisation):
Postcode:
County:
Main telephone number:
Main e-mail address:
Website address:
Twitter/Facebook:
Charity Number:
Company Number:

2. Your aims, services and activities:

Please give brief details of your organisation’s main aims:
Please give details of your organisation’s services / activities in bullet points (in no more than 90 words):

3. Income:

What was your organisation’s total income in the last financial year?
Less than £500 Over £20,000 and less than £100,000
Over £500 and less than £5,000 Over £100,000 and less than £250,000
Over £5,000 and less than £20,000 Over £250,000 (please specify):

4. Space to hire:

3VA provides information on community meeting rooms/spaces for hire. Would you like your venue included? / Yes No

5. Profiling the voluntary and community sector

The following questions help us build up a picture of the voluntary and community sector (VCS). With accurate information, we can help organisations to network with each other, share information and lobby for issues which concern the sector. We can also help government bodies value the sector’s role in service delivery and the contribution the VCS makes to building stronger communities.

Are your services targeted at any particular group? Who are your main beneficiaries?

No Yes, if so please tick:

Animals / Male / People with Sensory Impairments
Asylum Seekers/Refugees / Migrant Communities / People of Faith
Black and Ethnic Minority / Older people (over 55) / Single Parents
Carers / People in Housing Crisis and Homeless People / Substance Misusers
Children and Families / People on Low Income / Tenants and Residents
Ex-Offenders/Offenders / People with Learning Disabilities / Unemployed
Female / People with Mental Health Needs / Victims of Crime
LGBT / People with Physical Disabilities / Young people
Other
Where do you deliver your services? (Please tick maximum 3 main areas that apply)
Eastbourne Borough Wealden District Lewes District
Does your organisation (not parent organisation) operate further afield? (Please tick ONE only)
East Sussex Sussex (East, West South East region Nationally Internationally

Structure

What is your legal structure?(Please tick one box only)
Informal group (e.g. no constitution)
Community organisation with governing document (e.g. constitution)
Registered Charity
Registered both as a Charity and a Company Limited by Guarantee / Charitable Trust
Community Interest Company (CIC)
Registered Social Landlord
Charitable Incorporated Organisation (CIO)
Cooperative / Industrialised Provident Society (IPS)
Other – please specify:
Do you describe your organisation as a Social Enterprise? / Yes No
Social enterprises are like businesses, usually described as not-for-profit, which are run for the benefit of a community. This may be people in a geographical area or a particular social group, where the profits are reinvested or used for the community.
What year did your group start?
Number of staff employed over 16 hours per week:
Number of staff employed under 16 hours per week:
Number of volunteers including trustees:
Total number of hours contributed by all your volunteers combined (averaged per week):
How is your organisation funded?(Please tick 3 main funding sources that apply)
Charitable Trust
Town/Parish Council
District/ Borough Council
East Sussex County Council
Other (please specify): / Lottery
Fundraising events
NHS
Skills Funding Agency / Central government departments
Trading
Private donation, fees/membership
subscriptions

Main services you provide (Please tick 2 boxes MAXIMUM):

Advice, Information, Advocacy / Economic, Social and Community Development / Law, Crime, Human/Civil Rights
Animal Welfare / Education, Learning and Training / Marketing
Arts and Culture / Emergency Response/ Disaster Relief / Mediation
Befriending/Mentoring / Employment / Personal Development
Broadcasting and Media / Environment/Conservation/Recycling / Research
Campaigning/ Lobbying / Equality / Residents Association
Community Building/Space / Faith/ Religious Services / Rural Issues
Community Centre/Village Hall / Food Banks / Social Care
Community Safety/Justice / Funding/Financial Services / Sports and Leisure
Community Regeneration / Health / Substance/Alcohol Misuse
Community and Neighbourhood Action / Heritage / Support
Community Transport / Homelessness Services / Translation and Interpretation Services
Counselling and Therapy / Housing Provision / Volunteering
Credit Unions/Community Banking / Infrastructure Support / Other, please tick and
specify:
Domestic/Sexual Abuse / International Aid

What are your current priorities?(Please tick 3 boxes MAXIMUM):

Better Communication with Statutory Agencies / Effective Governance / More/Active Members/Trustees
Better Communication/ Internal / Engage Young People / More Support: Governance/Fundraising/ Admin
Better Employment Pathways for our Service Users / Greater Reach for our services / More volunteers/ Increase Recruitment
Better Facilities /Building / Greater Resident/ User involvement / Partnership Working
Building Successful Partnerships with Business / Improving the quality of our services / Secure/ Long-term Funding
Business Planning / Increased Public Support / Training of Staff/Volunteers
Campaign for Change to Government/Local Authority Policy / Increasing Public Understanding of What We Do/Problem We Address / Volunteer Retention
Demonstrating Impact / Investing in IT/ Digital Transformation / Website/Social Media/Publicity
Diversify Income Streams / Managing Risk/ Managing Change / Other
Diversify Services / More/Accessible Funding

6. Directory of Voluntary and Community Organisations and Services:

Do you want to be included in the online 3VA directory of members? / Yes No

7. Information you would like from 3VA:

Weekly 3VAe-newsletter / Yes No
Monthly Training e-newsletter / Yes No

8. Check List:

Does your group have a clearly defined purpose? / Yes No
Does your group have a governing document? (eg constitution) / Yes No
Does your group have a clear decision making mechanism? (eg a committee) / Yes No
Does your group have financial records and bank account in the name of your group? / Yes No
Does your group have all necessary insurances? (eg public liability) / Yes No
Does your group have all necessary policies in place? (eg confidentiality) / Yes No

Please note, answering ‘no’ to any of the above will not necessarily preclude you from 3VA membership.

What are your reasons for joining 3VA and what do you hope to gain as a member?
Declaration
I/We would like to become a member of 3VA (the Company) and have read and comply with 3VA membership criteria (see the 3VA Membership leaflet). I have read the 3VA Memorandum and Articles of Association and agree to contribute £1 to the charity’s assets if the company is wound up while I am a member or within one year after I cease to be a member. I agree to the above details being held on the 3VA database.

Name: Signature:

Position: Date:
The person signing this form will be the voting representative of their organisation and the key contact for information purposes for their organisation. If other people within the organisation would like to receive information from 3VA, please complete the attached form on page 4.

For Office use only

Approved at 3VA Trustee Board meeting on:
Signature on behalf of 3VA:

Additional contacts within your organisation

Please use this sheet for everyone within your organisation who would like information from 3VA.

Additional Contact 1:

Name of organisation:
Contact Name:
Position:
Address (if different from main address): / Postcode:
Telephone number:
E-mail address:

Information you would like from 3VA:

Weekly e-Newsletter / Yes No
Monthly Training e-newsletter / Yes No

Additional Contact 2:

Name of organisation:
Contact Name:
Position:
Address (if different from main address): / Postcode:
Telephone number:
E-mail address:

Information you would like from 3VA:

Weekly e-Newsletter / Yes No
Monthly Training e-newsletter / Yes No

Additional Contact 3:

Name of organisation:
Contact Name:
Position:
Address (if different from main address): / Postcode:
Telephone number:
E-mail address:

Information you would like from 3VA:

Weekly e-Newsletter / Yes No
Monthly Training e-newsletter / Yes No

Please return your completed form to: 3VA, 8 Saffrons Road, Eastbourne, East Sussex, BN21 1DG or email to