Expression of Interest Form

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Section 1-Data Protection Policy

Data Protection Policy

Any information you enter on this website will not be given to anyone else other than the project partners and our funder Power to Change. Beyond this, we will not share it unless we can't withhold it without breaking the law. We may use some of the data you give us for research purposes to help inform our research work but only as anonymised statistical information.

I accept

Section 2-Your Organisation

Name of Community Business:

Salutation

Primary Contact First Name:

Primary Contact Last Name:

Primary Contact Email:

Primary Contact Phone:

Secondary Contact First Name:

Secondary Contact Last Name:

Secondary Contact Email:

Secondary Contact Phone:

Organisation Address Line 1:

Organisation Address Line 2:

Organisation Address Line 3:

Town/City:

Postcode:

Region

Community Business Website

Please provide the URL of your organisation's website, if you have one:

Facebook URL Link to Project:

Twitter Handle for Project:

Other Social Media Handle for Project:

Primary Trade Sector:

Secondary Trade Sector:

Current Legal Form:

Registration number for current legal form:

Date established with current legal form:

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Section 5 - Your Area

Please provide up to three full postcode(s) that are representative of the areas that your community business is or will be engaging with or working in:

Postcode 1:

Postcode 2:

Postcode 3:

Please tell us about the area your community business is or will be working in:

Tell us about that area. What are the issues people face in the area that you are working in

IMD Decile http://dclgapps.communities.gov.uk/imd/idmap.html

Using your primary postcode, please indicate the level of deprivation of the neighbourhood that the organisation is active in, as recorded by the national Index of Multiple Deprivation (IMD). This information can be sourced using this map http://dclgapps.communities.gov.uk/imd/idmap.html - entering the appropriate postcode and then selecting the deprivation level it identifies for the neighbourhood e.g. “30% most deprived” from the dropdown above.

Section 6 - Your Community Share Offer Plans

What principal business assets will you need to secure i.e. land or buildings, and what is their approximate cost?

How much capital do you need to raise and how much of this can be raised through community shares from your community investors?

If you require a development grant, please indicate how much grant you will be applying for? (Please leave blank if you are intending to apply for equity only)

You can apply for up to £10,000 to help you finalise your community share offer. This may include further work on your business plan, community engagement work, governance structure and legal registration, the share offer document and the promotional campaign. We also expect you to apply for the Community Shares Standard Mark, as the final step towards launching your offer. You will be asked to provide detailed costs should you be invited to full application - this is just to give us a rough sense of your funding requirements.

Can you provide a rough estimate of the amount of equity you will be requesting from the Booster?

This can be up to a maximum of £100,000 or 50% of the maximum community share capital you hope to raise, whichever is the lesser. You will be able to request a different amount should you be invited to full application - this is just to give us a rough sense of your funding requirements.

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Section 7 - Other Sources of Support

We would like to know if you are receiving or are in the process of applying for other forms of support or funding.

Accessing other forms of support or funding will not disadvantage your application but rather help us understand where you're accessing your development funding from.

Are you receiving support (e.g. funding, advice) from other programmes to help develop your community share offer? (e.g. development funding, capital grant)

YesNo

Please state which programmes you are receiving (or have received) development support from?

Choose as many as you like by holding Ctrl/Command. If you are receiving support from an organisation or programme not listed, please select "Other" and provide details of the support in the question below.

Please give details of the support you have received for each of the programmes you have selected:

For each programme, please outline: 1) The nature of support i.e. development grant, consultancy 2) The activities it support i.e. business planning work 3) The value of support 4) Dates when it took place 5) The providers (if any) you worked with

Are you intending to apply or waiting for a decision on any of the following support programmes?

Please skip the question if you are not intending to apply or waiting for a decision on any other support programmes.

Please give details of the support you intend to receive for each of the programmes you have selected:

For each programme, please outline: 1) The nature of support i.e. development grant, consultancy 2) The activities it support i.e. business planning work 3) The value of support 4) Dates when it took place 5) The providers (if any) you worked with

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Land and building information

Are you planning to take on assets such as land or buildings?

What is the postcode of the building?

Who owns the land or building?

Are you planning an asset transfer (purchase) or lease?

Is it registered as an Asset of Community Value (ACV)?

Is the building listed?

If listed, what is your listed building number?

Please click here for more information

Is the building in a conservation area?

If the building is not listed/in a conservation area, does the building still have heritage value?

Option to upload supporting documents, eg. 'statement of heritage significance' etc.

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Section 8 - Your Investment Propositions

Which of the following investment proposition would you be interested in addressing as part of your Booster application:

No need to complete this section for a ReBoost application

Please provide a short summary explaining how you intend to explore and develop these investment propositions.

Section 10- Your Timetable

Please outline any key development milestones linked to your community share offer plans e.g. planning permission approval, purchase completions:

Do you have an intended community share launch offer date:

Is there any flexibility with this date:

YesNo

Section 9 - Final Checklist

Here is a summary of the required actions before submitting your Expression of Interest Form

Have you read the guidance thoroughly and understand the Power to Change eligibility criteria for funding?

Guidance can be found at: https://communitysharesbooster.org.uk/guidance

YesNo

We would like to arrange a short 15-30 min phonecall with you to discuss your Expression of Interest and review your Step-by-Step report, if you have started to complete it. Please arrange a time via this link:

https://calendly.com/alice-wharton/booster-eoi

Have you been able to schedule a phone call via the online meeting scheduler?

YesNo

How did you hear about the Booster Programme?

Other

Would you like to receive regular updates about Power to Change Funding and support opportunities, as well as community business sector events, training, webinars and research. By opting in to receive the Power to Change newsletter, you will receive updates and information about Power to Change and the community business sector. You can unsubscribe at any point.

YesNo

As the independent trust that supports community business in England, Power to Change wants to improve the diversity and inclusion of the community business sector. This guide helps you to make your community business more accessible and inclusive for people with disabilities. We'd like to understand a little about your background, so please could you fill in this very quick survey

On the next page you will be able to preview and submit your form. Please also use this opportunity to save a copy of your responses to PDF. You can do this by clicking the 'Print This Page' link on the review page.

Black, Asian and Minority Ethnic	Children
Disability (Learning)	Disability (Physical)
Ex-offenders	Homeless
Living in poverty	Long-term unemployed
Older people	Other specific target groups
Parents	People with addiction issues
People with long-term health conditions	People with mental health needs
Refugees and migrants	Victims of crime
Young people	No specific disadvantaged groups