[Type text]

Ref No

UnLtd Award Application Form

A: CONTACT DETAILS

  1. Personal Details

First name: / Surname:
Address:
Postcode: / National Insurance number:
Phone number: / Mobile:
Date of birth: / Email address:

Please note: we only use National Insurance numbers to check that you have not applied before. We will not use them for any other purpose. If you do not have a National Insurance number, we will use your last name, date of birth, or both.

  1. Under 18 – Please confirm your parent/guardian knows you have made this application by ticking this box
  1. Do you have any requirements or preferences in how we communicate with you following your application? (i.e email, phone, specific days, via another contact, etc). If so, please describe them below. This will help us to provide you with a service tailored to meet your requirements.
  1. Are you hoping your projectwill be for local, regional, national or international benefit?

Local
Regional
National
International
  1. Have you received support from UnLtd in the past?If so, what was the nature of this support?

6. Which area/s does your project focus on?(Check all that apply)

Education
Employability and skills
Housing and shelter
Access to basic services and utilities
Access to finance and legal services
Mental health
Physical health
Social cohesion
Environment
Other – please specify

7.Who will benefit as a result of your activities?(tick all that apply)

Children and families / People with high risk behaviours
Young people / Communities
Adults in need / People with disabilities
Older people / Other- please specify

B: About Your Venture

8.What is your project called?

9.Explain your idea and what is unique about it(maximum 200 words)

10.What have you done to identify there is a need for this project?Are there already similar services? (maximum 200 words)

11.What social need are you trying to address and who will benefit?What stage are you in developing it? (maximum 200 words)

C: About You

12.Are you applying on your own or are there others who are also leading on this?

On my own / With others

13.If you are applying with others, what is your specific role?

14. Tell us about your background and how it is relevant to your project. (maximum 200 words)

15.What skills and experience make you the right person to ensure thisproject is successful? Which areas do you need to improve?(maximum 200 words)

16.What are the obstacles/challenges that you are facing in developing your project?How do you think we can help?(maximum 200 words)

17. In addition to this support request, who else is currently supporting you with your project? What type of support are they providing?(maximum 200 words)

18.What other plans do you have in place to ensure your project continues to be successful? (maximum 200 words)

D: Support

19.What is the projected overall cost of your proposed project over the next twelve months?

20.What would you like this Award to financially support? (please refer to the eligible costs outlined in the guidelines)

Item of Expenditure / Cost
TOTAL

21. What funding have you already secured or are looking to secure for your project?

Funding Organisation / Amount / Secured

22.What other support do you believe you need from this Awards programme?

E: Data protection

We may share some of the information you have provided with other organisations to help run, fund and research activities for social entrepreneurs. By submitting this application, you agree to your data being used in this way. We will never share sensitive personal data that could identify you as an individual.

UnLtd and organisations working on UnLtd’s behalf may contact you in future to share news, offer other relevant opportunities for funding or support, or for research purposes. If you do not want to be contacted, please tick this box

F: References

Please provide the names and addresses of two referees. Referees should know you and support your project idea and can be a community worker, a teacher, a doctor or someone else who has an important position within the community. If you’re applying as part of a group, your referees should be people who know all the members of your group.

Referee 1
First name: / Surname:
Job title:
How do you know this person:
Address and postcode:
Contact number: / Email:
Referee 2
First name: / Surname:
Job title:
How do you know this person:
Address and postcode:
Contact number: / Email:

Your signature

I confirm that, as far as I know, all the information on this application form is true and correct. I understand that you may ask for more information at any stage of the application process or when the venture is running.

Your signature: / Date:

G: Equal Opportunities

Equal opportunities monitoring

We are committed to promoting equality of opportunity in all its activities. We aim to make sure our Awards are accessible to people of all different backgrounds. We expect all our staff, partners, suppliers and others with whom we work to follow our equal opportunities policy.

Please help us monitor this policy by giving us the following details. We will use this information solely for statistical purposes. It will not form part of your application assessment.

Gender

Male / Female

Disability

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
Prefer not to say

Ethnic group

Please tick one box that best describes your ethnic group.

White

English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy or Irish Traveller
Any other White background

Mixed/multiple ethnic groups

White and Black Caribbean
White and Black African
White and Asian
Any other mixed/multiple ethnic background

Asian/Asian British

Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background

Black/African/Caribbean/Black British

African
Caribbean
Any other Black/African/Caribbean background

Other ethnic group

Arab
Any other ethnic group
Prefer not to say
Current employment status
Please tick one box which best describes your main current occupation.
Employed full time / Looking after home of family
Employed part time / Unable to work owing to sickness or disability
Self-employed / Retired
Volunteering / In full time education
Unemployed / Other –please specify
Prefer not to say
Qualifications

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 2, intermediate 2 national qualification or equivalent
A levels, advanced GNVQ, NVQ 3, higher or advanced higher national qualifications or equivalent
HND, Degree and Higher Degree level qualifications or equivalent
Other qualifications, including foreign qualifications
Prefer not to say

All completed applications need to be sent to Tabby Mansha by Friday 21st March 2014 either by email at

or by post or hand:

Trafford Housing Trust

126-150 Washway Road

Sale

Manchester

M33 6AG

Please keep Thursday 27th March 2014 free as shortlisted applications will be assed via an exclusive panel of Entrepreneurs in Dragon’s Den format.