Reference No………………………… Date……………………
DECISION……………….
BASW INTERNATIONAL DEVELOPMENT FUNDGRANT APPLICATION FORM – CONFIDENTIAL
The purpose of this form is to help Trustees make an informed assessment of your application. BEFORE COMPLETING, PLEASE READ THE ACCOMPANYING CRITERIA. Please complete ALL SECTIONS clearly, fully, preferably typed and submitted online.
1. Personal detailsFull Name:
B.A.S.W. Membership Number:
Registration number with relevant Social Care Councils:
Personal address:
Postal code:
Tele no:
E-mail:
2. Social Work Qualifications
a. Social Work qualification:
Title:
Gained at:
Date:
b. Other relevant social work qualifications :
Title:
Gained at:
Date:
3. Current employment status
a. Employer details
Name and Address of Current Employer:
Current post:
Date post commenced:
b. If not currently employed, please give any relevant voluntary work or carer responsibilities:
c. Previous employment [give dates, employer and post]:
4. Total Costs
a. Anticipated total costs [please include as much information as you have available] per annum
Fees £
Travel expenses: £
Other [give details]: £
b. Amounts sought from other sources [indicate whether successful]
Employer: £
Other sources: (give details, including grants/bursaries) : £
5. Amount sought from the Fund
There is a MAXIMUM amount of grant, please see website for details.
Amount sought from this Trust: £
Towards the cost of :-
Fees £
Travel expenses: £
Other [give details]: £
Have you applied to either S.W.E.T. or the IDF before? If so, give details including dates.
6. Professional reference:
Name designation and contact details of a professional referee who can verify details of the application if required.
7. Grant Purpose:
Please outline here, in 200-350 words how the proposed funding meets the objects of the IDF as set out within the criteria.
[Please tick box] I agree to my details being kept for records
ü I confirm that the information in this application form is complete and accurate to the best of my knowledge and belief.ü I confirm that any funds received will be used exclusively for the purpose they are sought.
ü I confirm that I will comply fully with the terms set out with any offer of funds that may be made by the trustees.
SIGNATURE
Date:
Your application will be considered at the next available meeting of the Trustees.
RETURN [with enclosures] to: C/O BASW Foundation
16 Kent Street.
BIRMINGHAM B5 6RD
Company No: 09726160
Charity Registration: Pending
[April 2016]
BASW’s International Development Fund
We wish to ensure that access to IDF financial support reflects our commitment to equality of opportunity. To assist in this process we ask you to complete the following details.
Age
[ ] Under 25 [ ] 25 - 34 years [ ] 35 - 44 years [ ] 45 years and over
Gender
[ ] Male
[ ] Female
Ethnic Background (Which category best reflects your ethnicity?)
White
[ ] English
[ ] Irish
[ ] Scottish
[ ] Welsh
[ ] Any other White background
Mixed
[ ] White and Black Caribbean
[ ] White and Black African
[ ] White and Asian
[ ] Any other mixed background
Asian or Asian British
[ ] Indian
[ ] Pakistani
[ ] Bangladeshi
[ ] Any other Asian background
Black or Black British
[ ] Caribbean
[ ] African
[ ] Any other Black background
Other Ethnic Categories
[ ] Chinese
[ ] Any other ethnic category
Not Stated
[ ] Not stated
Disability
[ ] No disability
[ ] Deaf/hearing impaired
[ ] Dyslexic
[ ] In need of personal support and care
[ ] Multiple disabilities
[ ] Mental Health difficulties
[ ] Blind/Sight impaired
[ ] Other
[ ] Unseen disabilities (e.g. epilepsy, diabetes)
[ ] Wheelchair user/mobility difficulties