DrHadwen Trust - Board of Trustees 2015

Application form

Your details

Surname: / Forename(s): / Gender:
Address in full: / Email address:
Mobile telephone no.:
Where did you hear about this opportunity with the DrHadwen Trust?

Tell us about you – help us get a better idea about you and the skills and experience you could bring to the trustee board. Feel free to attach examples that illustrate what you have been doing and why you would suit this role.

1. Why do you think you should be selected to be on the DrHadwen Trust board of trustees representing young people? (Max 200 words)
2. What would you like to gain from this experience? (Max 50-100 words)
3. Are you able to commit to the following dates?
NB. If any of these dates are a problem for you, please do not continue with your application, as attendance at these meetings is key to taking on the role.
  • 5th September 2015 10:30-15:00 interviews in Hitchin
  • 12th November 2015 09:00-19:00 DrHadwen Trust event in central London
  • 5th December 2015 11:30-15:00 Trustee meeting in Hitchin
  • Dates in 2016 to be confirmed but will be 4 meetings per year at a similar time

Yes/No
4. Are you between the ages of 18 and 25 and able to travel to central London?
Yes / No
5. How do you currently represent young people? For example, what committees or groups have your previously sat on? What examples can you share to show this? (Max 200 words)
6. Explain your views on the use of animals in biomedical research. (Max 200 words)
7. Have you been involved with charities before? Examples might include volunteering, fundraising, campaigning, mentoring, befriending or caring. These might be opportunities you have taken up through an organisation or your school/college/university or that you have arranged yourself. (Max 200 words)
8. Do you have any skills and experience not covered in your previous answers? (Max 200 words)
9. Do you have any personal or professional links with the organisation? If so please specify.(Max 100 words)

Reference

Please provide details of a tutor, employer, adviser or anyone with whom you have an official relationship who would be able to comment on your suitability, and would support your application. We may contact referees before an interview is arranged with you.

Referee

NamePosition/job title

Address

Daytime tel. no.Relationship

If you have any questions about any of the above or need help completing the form please don’t hesitate to contact us.

Declaration

I declare that:

•I am over age 18.

•I am not an undischarged bankrupt.

•I have not entered into a composition or arrangement with creditors which includes an individual voluntary arrangement (IVA), and am not currently on the Insolvency Service Register.

•I have not previously been removed from trusteeship of a charity by a Court or the Charity Commission.

•I am not under a disqualification order under the Company Directors' Disqualification Act 1986.

•I have not been convicted of an offence involving deception or dishonesty (unless the conviction is spent).

•I am, in the light of the above, not disqualified by the Charities Act 2011 (sections 178 to 180) from acting as a charity trustee.

I declare that the information I have given in support of my application is, to the best of my knowledge and belief, true and complete. I understand that if it is subsequently discovered that any statement is false or misleading, or that I have withheld relevant information my application may be disqualified or, if I have already been appointed that appointment may be revoked.

Signed______Date______

Thank you for completing this application form and for your interest in becoming a trustee.

This form should be marked ‘confidential’ and returned to Kay Miller, preferably via email

by 5pm on 31 July to:

Dr Kay Miller – t: 01462 436819

Please note that all data will be held in the strictest confidence and in compliance with the Data Protection Act of 1998 and will only be used for the purpose of selection of trustees.