1000 Hours Recognition Scheme - Registration Form

The recognition scheme aims to recognise the achievements of volunteers who have given 1000+ hours to their volunteering. Volunteers are vital to Salford.

Please complete the following questions in full, including the monitoring information requested overleaf. This information will be used for statistical monitoring and treated in the strictest of confidence.

Name of Volunteer Nominated:
Volunteer’s Address (including postcode):
Name and address of Organisation:
When did the volunteer start volunteering withyou?
Are they still volunteering? Please circle Yes/No
If no, have they moved on to employment or training? / Yes / No
Between whichdates has your volunteer completed 1000+ hours?
On average how many hours per week does the
volunteer give to your organisation (this can
include time for travel, training and meetings)?
Please tell us the volunteers role title and give a
brief outline of the activities the volunteer is
involved with.
If you are registering the volunteer for a Combined Hours Certificate, please indicate here which other organisation(s) the volunteer is involved with and
ensure each of these completes Registration
Forms on behalf of the volunteer.
I confirm the above information is a true record of my volunteering
Volunteer Signature ………………………………………….. Date ……………………………..
Volunteer Coordinator’s/Authorised Person’s Signature …………………………………………
(This must be someone other than the nominated volunteer)
Please return your completed form to: Salford CVS (Volunteer Centre), FREEPOST (MR7797), The Old Town Hall, 5 Irwell Place, Eccles M30 0FN

This page is for the Volunteer to complete (this information will be kept confidential)

Which Age Group are you in? Please circle one

15-18 / 19-25 / 26-29 / 30-34 / 35-39 / 40-44
45-49 / 50-54 / 55-59 / 60-64 / Over 65 / Under 15

What is your current employment status? Please circle one.

Employed / Unemployed / Unable to Work
Houseperson / Retired / Student

What, if any, qualifications do you have?

Which ethnic group do you feel you belong in? Please circle one.

BangladeshiBlack AfricanBlack Caribbean

ChineseIndianPakistani

Other AsianJewishWhite

Other BlackMixed

Other (please specify)

Do you consider yourself to be disabled? YesNo

Do you have a long term illness or condition

that limits your daily activities?YesNo

If you need any assistance in completing this form please contact Volunteer Centre Salford on 0161 787 7795

For office use only

Received ……………………………………………………….
Inputted …………………………………………………......
Certificate awarded and sent ………………………………..

Data Protection Statement

Data Protection

  1. At no time will we provide any of your details to a third party without your permission.
  2. You have the right to see any information about you that we hold in a retrieval system such as a computer database or paper index system.
  3. You have the right to challenge us about any information relating to you we hold in a retrieval system and have this changed.
  4. You have the right for your details to be removed from a retrieval system.
  5. We will compile statistical data but this will never include personal identifiers (i.e. your name, address, telephone number etc)
  6. In order to keep you up to date with information and events we may include you in our mailing list or email list.
  7. We will never sell or give our mailing lists to a third party.

What will we do with the information you give us?

We will hold your information confidentially and store it on our computerised database, Vbase.

Volunteer Centre Salford

A service of Salford Community and Voluntary Services

A Company Limited by Guarantee 1948293 Registered Charity No 519361

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