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Application form Live UnLtd If you need assistance filling in this form, please contact UnLtd on 0845 850 1122 and ask for your nearest office and they will be happy to help you. Please write clearly in black ink or in ballpoint pen. You can continue on a separate sheet if necessary.

A

About you

1

Personal details

ThankQ number:

Date stamp:

(Staff use only)

First name:

Surname:

Project name (if you have one): Home address and postcode:

Phone (home):

Phone (day/work):

Phone (mobile):

Date of birth:

National Insurance Number:

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 or date of birth (or both).

Under 18 – Please confirm your parent/guardian knows you have made this application What is the name of your local authority area?

Do you have any special needs? If so, please state them below.

2 Have you had involvement with UnLtd in the past, either as a volunteer on a project or as the recipient of funding? Yes If ‘Yes’, tell us about it:

No


3 Are you applying as an individual or as part of a group? Please tick the appropriate box

Group

Individual

If you are applying as an individual please go to question 4

3a How many members are in your group? Please provide us with ONE of your group members’ contact details

First name:

Surname:

Address and postcode:

Phone (home):

Email address:

Phone (mobile):

Date of birth:

/

/

4 Have you spoken with an UnLtd member of staff about your application? Please tick the appropriate box

Yes, by phone

Yes, at an event/meeting

No

5 We'd like to know a bit about yourself and what it is that motivated you to make an application to Live UnLtd?

6 What is it that you hope to get out of setting up this project? Are there any skills you would like to develop?


B About your project 7 Please tell us about the main activities you will carry out as part of your project. What do you want to do, where will it be held and when? ‘Activities’ can include events, fundraisers and any online activities.

8 Which issue or problems are you planning to tackle with your project?

9 What do you hope will change as a result of your project? How will the community benefit?


10

What or who will benefit most from your project?

11

Tell us how much money you will need to undertake your project. Remember to refer to your guidance notes when completing your budget.

Item of expenditure

Amount needed £ £ £ £ £ £ Total

£


C References 12 You need to include the contact details of two referees with this application form. At least one of your referees should be someone of standing in your local community who has known you for at least six months e.g. current/former teacher/lecturer, doctor, youth worker, asylum support worker, community development worker, employment services/job centre advisor, youth offending team. For a detailed list please see the guidance notes. Once we receive your referee contact details we will write to them and request a written reference. ALL REFEREES MUST HAVE A WORK EMAIL ADDRESS AND PHONE NUMBER. Referee 1 First name:

Surname:

Job title: Address and postcode:

Contact number:

Email:

Referee 2 First name:

Surname:

Job title: Address and postcode:

Contact number:

Email:

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

Date:

(If stamped) Please return completed application form to:

Data Protection 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. From time to time, reports, newsletters and other materials may be sent to you. if you do not want to be contacted for these purposes please tick this box.

UnLtd Helpline 0845 850 1122


D

Equal opportunities

All our staff, clients, partners, suppliers and any other person who we work with must follow our equal opportunites policy and not to discriminate against anyone for any reason. Please help 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. Sex

Male

Do you have a disability?

Female Yes

No

26 to 36

37 to 47

If ‘Yes’ Please give details of your disability

Age

16 to 17

18 to 25

48 to 58

59 or over

Welsh

Irish

Please tick the box or boxes that best describe your ethnic origin. White

English Other White

Asian British

Indian Other Asian

Black or Black British

Caribbean Other Black

Chinese or other ethnic group

Scottish (Please give details)

Pakistani (Please give details)

African (Please give details)

Chinese Other ethnic group

Mixed

Bangladesh

(Please give details)

White and Black Caribbean White and Black African Other mixed

(Please give details)

White and Asian


Please tick the box which best describes your employment status. Self-employed

Full-time employed

Looking after your home or family

Unemployed

Part-time employed

On a government training scheme

Student

Retired

Unable to work due to sickness or a disability

What qualifications do you currently have? NVQ

CSE, GCSE or A levels Other

E

Professional qualification

(please tell us the level)

Self taught

Degree or postgraduate course

(please give details)

Monitoring

How did you find out about Live UnLtd? From an Award Winner

Newspaper

Word of mouth

Internet

Radio or TV

Leaflet or poster

Community project or local charity Other (please give details)


Advisor Details (Complete if different from parent or guardian) 11 – 17 ONLY If you are under 18 at the time of completing this application form, you must have a nominated advisor who is 18 or over. Your advisor should be somebody you trust who is able to stay involved and support you in your project from beginning to end. Your advisor must have a CRB Disclosure carried out by us. If you are successful we will send them the necessary forms automatically. They will not have to pay for this. NOTE: Your parent or guardian can act as your advisor. In the event they are your advisor, you do not have to complete this section, however they will need to have a CRB Disclosure carried out by us. They will not have to pay for this. Advisor Contact Details First name:

Surname:

Project name (if you have one): Home address and postcode:

Phone (home):

Phone (day/work):

Phone (mobile):

Date of birth:

Occupation

Email address:

/

/

UnLtd is the trading name for The Foundation For Social Entrepreneurs a company limited by guarantee. Registered in England No. 4180639. Registered Office: 123 Whitecross Street, London, EC1Y 8JJ. Registered Charity No. 1090393

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Live UnLtd Application Form