Expression of Interest Strategic Grants

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2 SECTION 1 - INFORMATION ABOUT YOUR ORGANISATION 1. The name you give here must match that on your constitutional document, bank statement & accounts. 2. The address at which your organisation is based or operates from. 1. Organisation Name: 2. Organisation Address: Address: Post Code: 3. Tell us the name of the person who will act as the spokesperson in explaining what you plan to spend the funds on. Assessment of EOIs will be based on the information you have supplied on this form, however, in certain circumstances we may need to contact you for further information or clarification. The Main Contact therefore needs to have a clear understanding of the organisation and the application. 3. Main Contact: Name: Address: Post Code: Daytime phone number: Position in Organisation: Fax: Address: 4. We will do all we can to meet any specific communication needs you may have and, wherever possible, we will try to contact you at a time and means to suit you. 4. Communication Needs: Do you have any communication needs we should be aware of? Please give details: When is the best time to contact you?

3 5. Please tick the box or boxes that describe your organisation giving any charity or company reference number. We can only give grants to community and voluntary organisations and groups with a constitutional document. 5. Organisation Details: When was your organisation set up? What type of organisation are you? (tick all that apply) Registered Charity q Registration Number: Awaiting Charity Registration q Registration Number: Company Limited by Guarantee q Company Number: Unregistered/Other Organisation q Please specify: 6. Explain the purpose of your organisation and what it actually does. Please refer to specific activities and your organisation s core aims and objectives which should be set out in your constitutional document. 6. Please tell us what your organisation does. What are its main activities? SECTION 2 BENEFICIARIES 7. Under the Strategic Grants scheme only organisations with a national presence or remit will be successful. For more information on Government Office regions, please visit: 8. Please detail the main beneficiaries of the work of your organisation and where possible provide numbers. 7. Which government office regions does your organisation target/benefit? (Please tick all that apply) North East q North West q Yorkshire and The Humber q East Midlands q West Midlands q East of England q London q South East q South West q 8. Which specific communities, minority ethnic and/or faith groups does your organisation target/benefit? Please include estimated numbers.

4 SECTION 3 - EXPERIENCE/TRACK RECORD 9. Under the Strategic Grants scheme only organisations with a proven track record of working with or in support of public services will be successful. Briefly provide some examples of your experience in this area. 9. What experience does your organisation have of working with or in support of public services? (Please provide specific examples) 10. Under the Strategic Grants scheme only organisations with a proven track record of communicating with their stakeholders will be successful. Briefly explain the methods your organisation uses to communicate. 10. How does your organisation communicate with your stakeholders and the communities they work with? 11. Please explain which organisations you have communicated with regarding this application and any groups that support your work. Letters of support will be requested should your organisation be invited to submit a full application. 11. Which organisations/communities/local groups have you discussed your application/proposed activities with? 12. Please explain how your organisation promotes diversity and equality. Do you have an Equal Opportunities or Diversity policy/ statement? Evidence of this will be requested should your organisation be invited to submit a full application. 12. How does your organisation promote diversity and equality?

5 13. Under the Strategic Grants scheme only organisations with a proven track record in one or more of these areas, over at least the last 2 years, will be successful. Please explain your experience and the length of time your organisation has worked in support of each outcome that applies. Further explanation and evidence of your experience will be requested should your organisation be invited to submit a full application. 13. Does your organisation have a proven track record of working in one or more of the following areas, over at least the last two years? (Please tick and give brief details for each outcome that applies). A Improving access and outcomes for Black & Minority Ethnic (BME) communities B Increasing BME confidence in public services q q C Tackling racism and extremism q D Improving community cohesion (bringing together communities from different races and faiths, and promoting a shared sense of belonging) q

6 14. Clearly explain the nature of the work that your organisation intends to carry out over the period of grant support. Please tell us whether our grant would be for specific items or a contribution to the total costs. (Funding for strategic partners could enable organisations to scale up work, market their service more widely, and evaluate and understand better how to deliver for different groups of people in different contexts) 15. The purpose of this question is for you to clearly explain the issues faced in the communities that your organisation benefits and provide brief details of any evidence which supports the need for these activities (i.e. surveys, research, statistical data). SECTION 4 - PROPOSED ACTIVITIES & COSTS 14. Briefly describe the nature of the work that you are applying for? 15. How do you know this work is needed? 16. Briefly explain the overall aim of your proposed work, whether this is additional to your existing activities and how this work will improve government and public understanding of what works in these fields. 16. How will this grant enable your organisation to develop and expand your work over the next 3 years and contribute to government and public understanding of how to reduce inequality and discrimination, improve cohesion and increase BME confidence in public services?

7 17. Please tell us whether you are already in receipt of funding for this work (and if so from which funding body and when the funding ends) or whether this work is new and additional to your core activities. 17. Are you already in receipt of funding for this work? Yes q No q If yes, where is this funding from and when does it end? 18. Please consider how much the proposed work will cost and then tell us: A) how much you wish to request from Connecting Communities Plus; B) how much will come from other sources/ funders; and C) the cost of the work in total. 18. What will these activities cost? A. How much money are you requesting from Connecting Communities Plus? B. How much will come from other sources? C. How much will this work cost in total? (A+B = C)

8 SECTION 5 DECLARATION 19. I confirm on behalf of my organisation that I am authorised to sign this declaration and, as far as I know, all answers to the questions on this form are true & accurate. Signed: Date: Position in Organisation: Please return all completed Expression of Interest forms to: A4e Fund Grant Distribution St James House Vicar Lane Sheffield S1 2EX Please note the deadline for receipt of completed Expressions of Interest is: 18 TH NOVEMBER 2005 If we do not receive your Expression of Interest before 12 noon on the above date, we will be unable to consider your application. NB. We will only consider the information we ask you for. We will not consider additional material from you, or return it to you, so please do not send attachments.