VCS Organisation - Application for Membership

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* 1. Organisation details:

Organisation: *

Address 1: *

Address 2:

City/Town:

County:

Post Code: *

Email Address:

Phone Number:

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* 2. If you have a website please provide address below:

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* 3. Is your organisation constituted?

Yes

If yes, what is the type of structure?

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* 4. Do you consider your organisation to be...? (Tick all that apply)

Community Group

Voluntary Organisation

Other (please specify)

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* 5. Please provide the relevant information below:

Charity Number (if applicable):

Company Number (if applicable):

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* 6. Please tell us about the staff you employ:

Number of employees (paid staff)

.....Total employee hours per week

Number of volunteer staff

.....Total (average) volunteer hours per week

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* 7. Who do you provide services for? (Tick all that apply)

Carers/parents

Children and young people

Faith communities

General public

Homeless people and those in housing need

Lesbian, gay, bisexual or transgender people

Offenders, ex-offenders and families

Older people

Other VCS organisations

People with addiction problems

People with health needs

People with mental disabilities

People with physical disabilities

Socially excluded/vulnerable/low income

Victims of crime and families

Rural communities

Other (please specify)

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* 8. Please comment here if you would like to be more specific about the target groups you provide servuces for.

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* 9. What is the purpose of your organisation/service? (Tick all that apply)

Accomodation, housing

Capacity building within VCS and social enterprise sector

Children and young people

Community development / engagement

Criminal justice

Culture (arts and music)

Economic development, employment, poverty relief

Environment

Health and wellbeing

Heritage

Leisure, sports and recreation

Lobbying group

Social justice

Support for families / individuals

Training, education, learning

Other (please specify)

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* 10. Please describe in more detail the purpose of your organisation and the services which you provide. If you have a website with this information, you can leave this field blank.

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* 11. Are you a member of one or more of the VCSA's forums of interest? (Tick all that apply)

Community Board Transport Consortium

County Sports Partnership

Criminal Justice Forum

Green Shropshire Xchange - GSX

Partners for Social Enterprise Shropshire

Shropshire Children & Young People's Summit

Shropshire Heritage Fourm

Shropshire Housing Support

Shropshire Information Advise, Advocacy and Guidance Forum

Shropshire Infrastructure Partnership

Shropshire Older People's Assembly (SOPA)

Shropshire Pan Disability Forum

Shropshire VCS Training Provider's Consortium

Visual Arts Network

Voluntary Sector Mental Health Forum of Shropshre and Telford & Wrekin

Voluntary Sectory Health and Social Care Forum

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* 12. How is your organisation funded? (Please tick all that apply)

Grant - Local

Grant - National / Out of County

Contracts - Local

Contracts - National / Out of County

Donations

Fundraising

Trading Income

Other (please specify)

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* 13. Do any of the following local bodies contribute financial support to your group/organisation?

Shropshire Council / Public Health

Clinical Commissioning Group

Police

Police and Crime Commissioner

Fire Service

Town / Parish Council

Partnership Body

Other (please specify)

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* 14. What is the geographical location of your service (e.g. whole county/central/north & central)?

All

North

Central

South

Rural areas only

Albrighton

Bishop's Castle

Bridgnorth

Broseley

Church Stretton

Cleobury Mortimer

Craven Arms

Ellesmere

Highley

Ludlow

Market Drayton

Much Wenlock

Oswestry

Pontesbury and Minsterley

Shifnal

Shrewsbury

Wem

Whitchurch

Telford & Wrekin

Other (please specify)

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* 15. What are your operational/opening hours?

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* 16. Please use this box for further comments about the service you provide:

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* 17. Are you a member of Shropshire Providers Consortium?

Yes

If you would like to receive information from Shropshire Providers Consortium, please visit www.shropshireprovidersconsortium.co.uk (opens a new window).

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* 18. Contact Information
Please provide the name and contact details for the main contact of your organisation i.e. who will be sent information and notification of meetings and events

Name:

Building name / no:

Address 1:

Address 2:

City/Town:

County:

Post Code:

Email Address:

Phone Number:

Statement of Commitment

Having read the Terms of Reference for the Shropshire Voluntary and Community Sector Assembly I am, on behalf of my organisation, willing to commit to support the Aim, Purpose and Objectives of the Assembly and wish to apply for membership. I understand that any alterations to the Terms of Reference can only be made by a majority decision of the Assembly Board at the Annual Meeting and that due notice, as set out in the Terms of Reference, must be given to all members of any changes. I am authorised to agree to this Statement of Commitment on behalf of the governing body of the above named organisation.

Please read the following statements:

I am willing to commit to support the Aim, Purpose and Objectives of the Assembly
I have read and understood the Terms of Reference for the Shropshire Voluntary and Community Sector Assembly and believe that my organisation meets the criteria set for membership
I can provide evidence to support this, and am willing to do so including: My organisation's Terms of Reference or Governing document
I am authorised to sign to join the Assembly on behalf of the governing body of the organisation/group named above

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* 19. Please tick if you agree to the statement below:

I agree to the Statement of Commitment above.

Data Protection Statement

Details of Assembly members will be held on the VCS Assembly database. It will use the contact details to circulate information including invitations, newsletters and other relevant items relating to the work of the Assembly. Please do your best to provide an email address as this is the most cost effective form of communication

The information will not be shared with third parties outside Shropshire Partnership Organisations without seeking the permission of the individuals. The information will be updated periodically and any organisation can ask to have their details amended or removed from the database at any time

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* 20. Please tick if you agree to the statement below:

I agree that the Assembly can use the details provided and share them with members of the Shropshire Partnership.

Please review this form before clicking the button below to submit your application

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* 1. Organisation details:

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* 2. If you have a website please provide address below:

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* 3. Is your organisation constituted?

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* 4. Do you consider your organisation to be...? (Tick all that apply)

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* 5. Please provide the relevant information below:

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* 6. Please tell us about the staff you employ:

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* 7. Who do you provide services for? (Tick all that apply)

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* 8. Please comment here if you would like to be more specific about the target groups you provide servuces for.

Question Title

* 9. What is the purpose of your organisation/service? (Tick all that apply)

Question Title

* 10. Please describe in more detail the purpose of your organisation and the services which you provide. If you have a website with this information, you can leave this field blank.

Question Title

* 11. Are you a member of one or more of the VCSA's forums of interest? (Tick all that apply)

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* 12. How is your organisation funded? (Please tick all that apply)

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* 13. Do any of the following local bodies contribute financial support to your group/organisation?

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* 14. What is the geographical location of your service (e.g. whole county/central/north & central)?

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* 15. What are your operational/opening hours?

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* 16. Please use this box for further comments about the service you provide:

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* 17. Are you a member of Shropshire Providers Consortium?

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* 18. Contact Information Please provide the name and contact details for the main contact of your organisation i.e. who will be sent information and notification of meetings and events

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* 19. Please tick if you agree to the statement below:

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* 20. Please tick if you agree to the statement below:

* 18. Contact Information
Please provide the name and contact details for the main contact of your organisation i.e. who will be sent information and notification of meetings and events