Groupapplicationform
HE SocialEntrepreneurshipDo ItAward
Ifyou needassistancefillinginthis form,pleasecontactyour University team on 0161 606 7265 or UnLtdon08458501122andaskfor yournearestofficeandtheywill behappytohelpyou.Pleasewriteclearlyinblackinkorinballpointpen.
Youcan continueonaseparatesheetifnecessary.
AAbout you
1Personal details
ThankQnumber:
(Staffuseonly)
Date stamp:
Firstname: / Surname:Projectname (if you have one):
Homeaddress:
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.
Which University of Manchester Faculty and School do you work in?
Faculty:School:
Areyou applying as a member of staff or academic?
Please tick the appropriate box
Memberof StaffAcademic
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.
BEqual 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)
CMonitoring
Howdid you find out about the HEI Social Entrepreneurship Awards?
Froman Award WinnerNewspaperWord of mouth InternetRadio or TV Leaflet or poster Community project or local charity
Other (please give details)