LeadApplicationForm

HE SocialEntrepreneurship Do ItAward

Ifyou needassistancefillinginthis form,pleasecontactyour University team on 01223 330758or UnLtdon08458501122andask for yournearestofficeandtheywillbehappytohelpyou.

The ‘Do It’ Awards support individuals who are confident their ideas will work and have the basic skills to deliver them, supporting their development of an entrepreneurial idea in a more mature phase..You can apply for a maximum of £2,000 as a ‘Do it’ Award before Sunday 9 March 2014.

AAbout you

1.Personal 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.

WhichHigher Education Institution do you currently work for/study at/ are a recent graduate of? We are terming recent graduates as those who have graduated in the last 12 months. Those who graduated earlier will not be eligible..

Areyou applying as a member of staff or student?

Please tick the appropriate box

Memberof StaffStudent

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.

2.Have 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. Are you applying as an individual or as part of a group?

Please tick the appropriate box

Onmy ownPart of a group

Ifyou are applying as part of a group, what is your role within the group?

4. Have you spoken with an UnLtd or a member of the UnLtd Social Entrepreneurship Awards project team at the University of Cambridge about your application?

Please tick the appropriate box

Yes,by phoneYes, at a meeting/surgeryNo

5.Please provide details about your background, including any previous involvement in community activities.

BAbout your project

6.Please provide a brief description of your project, outlining the social or environmental need the project aims to address, and how it addresses this need.

7. Please give a brief history of your project to date, including what has been achieved with any previous UnLtd grants.

8.Pleaseoutline the number of current/future beneficiaries of the project, who these are and how they will benefit.

9.How do you know that there is a need or demand for your project?

10.What are your main reasons forbeing involved in this project?

11.Pleaseoutlinetheanticipatedlearningpoints,alongwithwhatyouhopetogainbydevelopingthisproject

12.Please indicate where you expect the project to be in one year’s time, if you are awarded an

UnLtd grant

13.Do you anticipate any issues with implementation? If so, how will you overcome these?


14.Whatsupport wouldbebeneficialinordertomakeyourprojectasuccess?

15.Please outline the financial requirements of your project.

Item of expenditure / Amount needed
Total:

16.Of the total amount needed, tell us how much you are looking to apply for and how much you need to raise from other sources

Source / Amount
University of Cambridge Social Entrepreneur Awards
Total:

17.Where relevant, please expand on your plans for revenue generation – how will you work towards making the project sustainable?


CReferences

18 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:

19Your 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:

Please return completed application forms toKathryn Muir, Knowledge Exchange Officer,

University of Cambridge, The Pitt Building, Trumpington Street, Cambridge CB2 1RP, or email to by midnight on Sunday 9 March 2014 .

DataProtection Act 1998

UnLtd and the Millennium Awards Trust collect and share elements of this information with other organisations

DEqual 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.

SexMaleFemale

Doyou have a disability?

If‘Yes’ Please give details of your disability

YesNo

Age16 to 1718 to 2526 to 3637 to 4748 to 5859 or over

Pleasetick the box or boxes that best describe your ethnic origin.

WhiteEnglishScottishWelshIrish

OtherWhite(Pleasegive details)

AsianBritish

Blackor Black BritishCaribbeanAfrican

OtherBlack(Pleasegive details)

Chineseor other ethnic groupChinese

Otherethnic group(Pleasegive details)

MixedWhiteand Black CaribbeanWhite and Asian

Whiteand Black African

Othermixed

(Pleasegive details)

Pleasetick the box which best describes your employment status.


Self-employed / Full-timeemployed / Lookingafter your home or family

Unemployed /
Part-timeemployed / Ona government training scheme
Student / Retired / Unableto work due to sickness or a disability

Whatqualifications do you currently have?

NVQ(please tell us the level)Professionalqualification

CSE,GCSE or A levelsSelf taughtDegree or postgraduate course

Other(please give details)

EMonitoring

Howdid you find out about these Awards?

Froman Award WinnerNewspaperWord of mouth InternetRadio or TV Leaflet or poster Community project or local charity

Other (please give details)