Expression of InterestForm
HE Support SocialEntrepreneurshipBuild It Award
Ifyou needassistancefillinginthis form,pleasecontactyour University team on
AAbout you
1Personal details
Referencenumber:
(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.
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
3Are you applying as an individual or as part of a group?
Please tick the appropriate box
Onmy ownPart of a group
4Have you spoken with an UnLtd or Loughborough University member of staff about your application?
Please tick the appropriate box
Yes,by phoneYes, at a meeting/surgeryNo
FUNDING
Project description (one sentence):When did you start your project?
What legal structure do you have in place?
What wasyour project’s income level for the last 12 months?
How much of this was grants income or donations to your project?
How much of this was earned income?
How much income have you generated since the start of the project? / £
£
£
£
How much funding is required to take your project to the next stage?
Amount requested from: / Amount:UnLtd
Others / £
£
Please provide an outline of the major items of expenditure you are applying for. If applying solely for living expenses, please list only one item.
Expenditure: / Amount:Total
Please type your answers under each question ensuring you do not exceed the word limit.
ABOUT YOUR PROJECT AND YOU
1. The Social Problem
- Please describe the specific social problem that your project is trying to address. (Max 200 words)
- Please state the target beneficiaries of your project. (Max. 100 words)
- What evidence do you have that your beneficiaries’ needs are unmet? (Max. 200 words)
- Why are other groups/agencies failing to address the social problem you identify? (Max. 200 words)
2. Your Solution
- What products and/or services do you deliver to solve this social problem? (Max. 200 words)
- Who are your actual and potential customers in this market? (Max. 200 words)
- Please provide numbers on:
Previous Customers:
Current Customers:
Prospective Customers:
3. Social Impact
- How do you measure and monitor the social impact of your project? (Max. 200 words)
- What measurable social impact has your project demonstrated so far? (Max. 200 words)
- Please state the number of direct beneficiaries you have worked with.
- Please state the number of beneficiaries you anticipate to work with during the next 12 months.
4. Competition
- Who are your main competitors? (Max. 200 words)
- How do you distinguish yourself from them? (Max. 100 words)
5. Sales & Marketing
- Please outline your sales and marketing activities. (Max. 200 words)
6. You & Your Team
- What is your current position within the project? (i.e. Director, Founder, Chief Executive, paid member of staff) (Max. 200 words)
- Please provide background details on yourself as the founder or key driver in this project and your motivations for undertaking it. (Max. 200 words)
- Please state the number of employees of your project and the roles they fulfil. (Max. 100 words)
- Please state the number of volunteers involved in your project and the roles they fulfil. (Max. 100 words)
- Please outline the skills and experience of any board members, mentors or key supporters. (Max. 100 words)
- Please provide details on any partnerships you have in place. (Max. 100 words)
7. Progress to date
- Please outline the achievements you have made to date.What have been your key milestones? (Max. 200 words)
8. Future Plans
- Please outline your plans for your project in the next 12 months.What are your key milestones? (Max. 200 words)
9. Finance
Please provide a financial overview of your project for the last 12 months and a forecast for the next 12 months.12 month history / 12 month forecast
Income
Total grants
Total sales
Total income:
Expenditure
Fixed costs
Variable costs
Total expenditure
Total profit / loss
TAILORED SUPPORT
The HE Support Social Entrepreneurship Awards Programme provides a support package to help you achieve sustainability and growth for your project.
Please outline specific areas of support you potentially require. E.g. legal advice, marketing strategy, investment readiness etc. Please provide specific details. (Max. 200 words)
CReferences
14 You should provide the names and addresses of two referees. Referees should know you and
supportyour project idea and can be a community worker, a teacher, a doctor or someone else of
prominencewithin the community. Please note that one of the referees must be a responsible member of staff at the HEI where you study/work e.g. Head of department or Head of school. They will be contacted to cross-check that they fully endorse and support your project.
Ifyou would like to apply as a group, please ensure that the referees are familiar with all of the members of the group.
Referee 1
Firstname: / Surname:Jobtitle:
Addressand postcode:
Contactnumber: / Email:
Referee2
Firstname: / Surname:Jobtitle:
Addressand postcode:
Contactnumber: / Email:
15Your signature
Iconfirm that as far as I know, all the information on this application form is true and correct. I understand
thatI may be asked 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