Groupapplicationform
HE SocialEntrepreneurship Try It or Do It Award
Ifyou needassistancefillinginthis form,pleasecontactyour University team on or UnLtdon08458501122andaskfor yournearestofficeandtheywill behappytohelpyou.Pleasewriteclearlyinblackinkorinballpointpen.
Youcan continueonaseparatesheetifnecessary.
AAbout you
1Personal details
ThankQnumber:
(Staffuseonly)
Date stamp:
Firstname: / Surname:Projectname (if you have one):
Homeaddress and postcode:
Phone(home): / Phone(day/work):
Phone(mobile): / Dateof birth://
NationalInsurance Number: / Emailaddress:
Pleasenote:Weonly use National Insurance numbers to check that you have not applied before. We will not use them for any other purpose. If youdo not have a
NationalInsurance number, we will use your last name or date of birth (or both). We will not consider applications from individuals who are under 16.
WhichHigher Education Institution do you currently work for/study at?
Areyou applying as a member of staff or student?
Please tick the appropriate box
Memberof StaffStudent Graduate
Doyou have any special needs? If so, please state them below.
Pleasetick here if you are happy to share your contact details with other Award Winners.
2Have you previously been the recipient of an UnLtd Award?
YesNo
If‘Yes’, please provide a brief description of the project and tell us the name of the Award Scheme?
3 Pleaseprovidedetailsaboutyourbackground,includinganypreviousinvolvementincommunityactivities.
4 Please telluswhyyouwant todevelop thisproject. What areyour main reasons forbeing involved?
5 Pleaseoutlinetheanticipatedlearningpoints,alongwithwhatyouhopetogainbyundertakingthisproject.
6 Pleasetelluswhatroleyouwillhaveinthegroupandwhoistheleadapplicant?
7Your signature
Iconfirm that as far as I know, all the information on this application form is true and correct. I understand
thatUnLtd may ask for more information at any stage of the application process or when the project is running.
Yoursignature:Date:
(Ifstamped) Please return completed application form to:
DataProtection Act 1998
UnLtd and the Millennium Awards Trust collect and share elements of this information with other organisations for research, educational, training administrative and funding purposes, and to ensure that the Fellowship and Trust comply with regulations and required standards. Statistics will be gathered to monitor provision and to plan future provision. We do not trade or share our mailing lists with any other body.
Marketing
Howdid you find out about the Award you are applying for?
Personal referral/word of mouth
University staff member or student UnLtd staff member
Another UnLtd Award Winner Another organisation or individual
Internet
University website UnLtd website
Another website
Personal referral/word of mouth
University staff member or student UnLtd staff member
Another UnLtd Award Winner Another organisation or individual
Marketing and media
Marketing e-mail/mailshot Newspaper Radio or TV
Social media (eg. Twitter, Facebook, LinkedIn Leaflet or poster
Other(please give details)
Role and Area of Study
Which of the following best describe/s your position in the university?
Tick all that apply
Undergraduate student Postgraduate student Recent graduate
Academic staff Professional/administrative staff
Other(please specify)
If relevant, what is your main academic discipline or area of study?
Please tick one only
Agriculture, veterinary and food scienceAnthropology and development studies
Architecture/built environment/planningBiological sciences
Business and management studiesChemistry/physics/environmental sciences
Communication, cultural and media studies, library and information management
Computer science/informaticsCreative and performing arts/design
EducationEngineering
Geography, environmental studies and archaeology
HumanitiesLaw
Mathematical sciencesMedicine, public health and health care
Psychology, psychiatry and neuroscienceSocial work and social policy
Sociology, politics and economicsSport and exercise sciences, leisure and tourism
Not applicable
Other(please specify)
Your Social Venture or Project
What type/s of benefit will you create?
Please tick any that apply.
EducationEmployment and skillsHousing and shelter
Mental healthPhysical healthSocial cohesion
EnvironmentAccess to basic services and utilities
Access to finance and legal services
Other(please specify)
Who will benefit as a result of your activities?Please tick any that apply.
Children and familiesYoung peopleAdults in need
Older peoplePeople with disabilitiesCommunities
People with high-risk behaviours, e.g. (ex-)offenders, people with addictions
Other(please specify)
Is your venture new or is it already set up?
New Already set up
What impact do you expect the Award to have on you and your venture?Please tick all that apply
Development of my ideaDevelopment of my skills
Increased geographical operationIncreased financial sustainability
Increased investment readinessIncreased networks and contacts
Establishment of legal form/governance arrangements
Development of operational capacity – systems and products
Development of operational capacity – employment of staff
Don’t know Other(please specify)
How do you intend to use the Award? Please tick all that apply
Market researchMarketing – website development
Marketing - other than website developmentProduct development
Property purchase/refurbishmentPurchase of new equipment
Running/operating costsLiving expenses
Training in a skill needed for my ventureDon’t know
Legal costs (establishing legal forms/governance arrangements)
Other(please specify)
Equal Opportunities
Allour staff, clients, partners, suppliers and any other person who we work with must follow our equal opportunities policy and not to discriminate against anyone for any reason.
Pleasehelp us monitor this policy by giving us the following details. We will use the information we ask for on these sheets solely for statistical purposes, and it will not form part of your application assessment. We will separate this sheet from your application form when we receive it.
GenderMaleFemale
Are your day-to-day activities limited because of a health problem or disability that has lasted, or expected to last, at least 12 months?
Yes, limited a little Yes, limited a lot No
Age16 to17 18 to 25 26 to 36 37 to 47 48 to 58 59 or over
Pleasetick the box or boxes that best describe your ethnic origin.
WhiteEnglish/Scottish/Welsh/Northern Irish/British
Irish
Gypsy or Irish Traveller
Any otherWhite background
Asian/AsianBritish
Black/African/Caribbean/Black British
CaribbeanAfrican
Any otherBlack/African/Caribbean background
Other ethnic groupArab
Any otherethnic group
Mixed/Multiple ethnic groupWhiteand Black CaribbeanWhite and Asian
Whiteand Black African
Any other Mixed/Miltiple ethnic background
Pleasetick one box which best describes your main current occupation.
Self-employed / Full-timeemployed / Lookingafter your home or family
Unemployed /
Part-timeemployed / Volunteering
Full time education Retired Unable to work due to sickness
or disability
Unableto work due to sickness or a
disability
Other(please give details)
Please tick one box that best describes your highest level of qualification.
No formal qualifications
NVQ 1, intermediate 1 national qualification or equivalent
GCSEs, intermediate GNVQ, NVQ 3, higher or advanced higher national qualifications
or equivalent
A Levels, advanced GNVQ, NVQ3, higher or advanced higher national qualifications
or equivalent
HND, Degree and Higher Degree level qualifications or equivalent
Other qualifications, including foreign qualification