Profile:

Organisation overview

This is your organisation overview that we will keep on file. You will not need to submit this information to us again.

1.1Name of your organisation*

1.2Address details

Address*
Post Town* / Post Code*
Web Address

Main Contact Person (these are the details that will be used for correspondence purposes)

Title* / Forename* / Surname*
Role
Daytime phone no.* / Mobile phone no.
Email
Address / (if different from above)
Post Town / Post Code

1.3When did your organisation start?Month*Year*

1.4What type of organisation are you? (Check all that apply)

Unincorporated club or association

Community Interest Company.

A branch of a larger regional or national organisation (Please specify):

A registered charity (If yes please give your number):

A registered company(If yes please give your number):

Other:Please specify:

1.6Staffing and volunteers

How many of each of the following are involved in the organisation (Numbers):

Management committee / Full time Staff / Workers
Volunteers (not including committee) / Part time Staff / Workers

1.7What is your average income over last 3 years (or since the organisation started)?

£ per year

2.1In which Local Authority area(s)do you work?

Leicester City LeicestershireRutland

2.2In which area (estate, village, town or borough) do most of the people who benefitlive?

2.3Please describe the aimsof your organisation and the activities or services you provide:

2.4Describe the disadvantage/needthat your organisation meets and what difference your work will make:

2.5Describe the beneficiary involvement in your organisation’s work or services (how are target users engaged in your work?)

3.1Please select from the drop down menu(in the box below)the mainbeneficiary group thatuses your services.

Please selectChildren and Young PeopleOlder PeopleNEETLong-term UnemployedDisadvantaged / Low incomeLone ParentsHomeless PeopleRefugees / Asylum seekersPeople with general health issuesPeople with learning difficultiesPeople with mental health difficultiesPeople with weight / obesity issuesAlcohol / Drug addictionBME groupsEx-offenders and PrisonersLesbian, Gay, Bi-sexual and Transgender groupsFamiliesCarersLocal residentsPeople in Rural AreasPeople in Urban AreasMigrant workersMenWomen

Now let us know all other groups who benefit (please check all that apply)

Children & Young People / People with learning difficulties / Families
Older People / People with physical disabilities / Carers
NEET * / People with mental health difficulties / Local residents
Long term unemployed / People with weight / obesity issues / People in Rural Areas
Disadvantaged / Low Income / Alcohol / Drug Addiction / People in Urban Areas
Lone parents / BME groups ** / Refugees / Asylum Seekers
Homeless people / Ex Offenders and Prisoners / Lesbian, Gay, Bi-sexual & Transgender groups
Men / Women / Other(please state)

* Not in Education, Employment or Training** Black and Minority Ethnic

3.2Please select from the drop down menu(in the box below)themain age group that uses your services.

Please selectEarly Years (0-4)Children (5-12)Young People (13-18)Young Adults (19-25)Adults (26-65)Seniors (65+)

Now let us know all other age groups who also benefit (please check all that apply)

Early Years (0-4) / Young People (13 – 18) / Adults (26 – 65)
Children (5 – 12) / Young Adults (19 – 25) / Seniors (65+)

3.3Please select from the drop down menu(in the box below)the main issue your group works with.

Please selectArts & CultureCommunity Support & DevelopmentCounselling/Advice/MentoringCrimeDisability & Access issuesEducation & TrainingEmployment & LabourEnvironment/Recycling/Renewable energiesHealth & WellbeingHousingIT/TechnologyPoverty & DisadvantageRacial & Cultural IntegrationReligionRural IssuesSocial InclusionSocial Services & ActivitiesSport & RecreationSupporting Family LifeTransport IssuesVolunteeringSocial Enterprises

Now let us know all other issues addressed (please check all that apply)

Arts and Culture / Health and Wellbeing / Social Inclusion
Community Support
and Development / Employment / Social Services and
activities
Counselling / Advice /
Mentoring / Education and Training / Sport and Recreation
Disability and Access issues / Poverty and disadvantage / Supporting family life
Racial and
Cultural Integration / Volunteering / Others (please state)

4.1Details of the organisation’s bank/building society account:

Name of Bank/Building Society*
Branch Address*
Post Code*
Account Name*
Account Number* / Sort Code*

4.2 How many signatories are required to authorise cheques?*

4.3 Please confirm you have the following documentation and can submit them on request:

A signed copy of your organisation’s set of rules / terms of reference / constitution

A signed copy of your most recent annual accounts (unless your group has been running for less than a year)

A copy of a bank statement dated in the last 3 months (for the account detailed above)

Declaration:
We understand completing this profile does not guarantee funding, and agree that we are willing to supply further information on request. All information provided is correct as far as we are aware. We understand that Leicestershire and Rutland Community Foundation can take legal action to recover funds from an applicant who has provided fraudulent information
Please note that the signatory must be a committee member
Name:
Position in the organisation: Date:
Please submit your profile form by e-mail to or send a printed copy by post to LRCF, 3 Wycliffe Street, Leicester, LE1 5LR if you are unable to complete the form electronically.
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Leicestershire and Rutland Community Foundation @LLRFoundation

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