Application Form - BAT Skills Bursary Programme Please read the guidance notes carefully. They explain how to fill in the form. If you cannot fit your answers into the space provided please continue on a separate sheet of paper. Section 1 Your contact details Name, address and contact numbers Title (Mr/Mrs/Miss/Ms) Date of Birth Address Best time to contact Section 2 Employment and Education Current employment status If you are not currently working, please go on to the next question. Employer Your job title Employer s address Website www. - 1 -
Current volunteering details Organisation Your role Address Website Number of hours you volunteer per week Which days? www. Previous voluntary activity Dates (most recent first) Organisation Roles/Position Previous paid employment Dates (most recent first) Employer Roles/Position - 2 -
Education and Training Dates (most recent first) School / College / Work Subject studied and qualification gained Section 3 Training requirements Type of training What training are you applying to County Durham Community Foundation for? Course name Location (college/work) Start date Duration Qualification to be achieved Current skills What skills do you have that lead you to believe that you can achieve this training? Can you commit to the training? If you are successful in obtaining this bursary, you will be required to commit to regularly attending your training as well as your voluntary work for the duration of the course. Do you envisage any problems or issues in committing to this training? Yes No - 3 -
If yes, please give details: Joint applications If you are making an application jointly with other people, please give us their name(s) so we can consider the applications together. Section 4 Benefits Benefits to you How would a bursary help you in your community and voluntary work? What would it enable you to do that you cannot do now? - 4 -
Benefits to your voluntary organisation or local community How would a bursary help your voluntary organisation or local community? Section 5 Financial information Support required What do you require the financial support for, in order for you to achieve your goal and carry out the training? Training costs Childcare Equipment Special needs Other (please specify) Actual costs All amounts given must have been costed out accurately, this includes obtaining quotes from training providers, childcare operators or equipment suppliers. Item Description Cost (Inc. VAT) Funding secured Sub-totals tal costs Funding required - 5 -
How much are you requesting from us? How much are you requesting from elsewhere? How much are you funding yourself? Other sources of funding Where else have you applied for funding? Has the funding been approved? Is it guaranteed? Section 6 Independent referees Please provide the names of two people who are familiar with your voluntary work, or who can vouch for you personally and could give you a reference for this application (one of these must be your line manager within the organisation you volunteer for). Referee 1 Title (Mr/Mrs/Miss/Ms) Address Best time to contact How do you know this person? - 6 -
Referee 2 Title (Mr/Mrs/Miss/Ms) Address Best time to contact How do you know this person? Section 7 Additional information Please give us any additional information about yourself that you feel will add value to this application, but that is not already covered elsewhere in the application form. If you are 25 or under, are you or have you ever been in local authority care? Yes No Are you registered disabled? Yes No - 7 -
Section 8 Declaration I confirm that all information stated in this application form is true and correct, to the best of my knowledge. I know of no practical reason why I would not be able to take up this bursary if it were offered to me. Name Signed Dated Section 9 Contact details Completed application forms should be returned to Clare Johnson, Grants Officer. If you have any difficulties completing this form, or would like to receive additional guidance before submitting it, please do not hesitate to contact a member of the grants team. Our details are: County Durham Community Foundation Victoria House Whitfield Court St Johns Road Meadowfield Industrial Estate Durham DH7 8XL Tel 0191 378 6340 Fax 0191 378 2409 info@cdcf.org.uk www.cdcf.org.uk Charity no: 1047625 Company no: 3072153 ENTRUST no: 581043-8 -