Black Thrive Application Form

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It is STRONGLY recommended that you tick the 'Save my progress and resume later' box in top right hand corner so that you are able to save your work regularly.

If you would like to see a preview of all the questions on the form, please click the links for Applications from Individuals or Applications from Organisations.

We do not have a word count on our forms but please be brief and concise.

Please note at the end of the form, when you click 'Submit', you will get a preview of your completed form which you can print and review before you finally submit. Also after submission, you will get an email copy of your application form.

Who is applying?

APPLICANT

Organisation Name

Title

First Name

Last Name

Job Title

Mobile Phone

Phone

Email

Street

City

Post Code

ORGANISATION DETAILS

Phone

Website

Additional senior contact for application

Title

First Name

Last Name

Email

Telephone

Role in organisation

This contact must be different from the person completing the form. For charities, it must be a trustee (ideally treasurer or chair). For companies, it must be a director.

Organisation Background and Aims

Is your organisation led by Black people?

We define ‘led by’ as when more than 50% of an organisation’s senior leaders (trustees and managing staff) are Black

Is your organisation led by disabled people?

We define ‘led by’ as when more than 50% of an organisation’s senior leaders (trustees and managing staff) are disabled

What is your organisation's latest annual turnover?

Organisation Type

Charity Number (if app.)

Company No (if app.)

Is your organisation a registered Living Wage Employer?

We are a Living Wage Funder. We seek to ensure that all posts which we wholly or partially fund pay the Living Wage unless there are particular reasons for this not to happen. Organisations do not need to be registered Living Wage employers to apply to us but we do encourage organisations to consider whether this is a possibility for them.

Has your organisation had any serious incidents in the last three years?

A serious incident is an adverse event, whether actual or alleged, which results in or risks significant: • harm to your organisation’s beneficiaries, staff, volunteers or others who come into contact with your charity through its work • loss of your organisation’s money or assets or damage to your organisation’s property • harm to your organisation’s work or reputation

Serious Incidents - Please give details

APPLICANT DETAILS

Gender and Gender Identity

Ethnicity

Disability - Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?

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Project Title

100 characters max

Estimated Project Start Date (DD/MM/YYYY)

Estimated Project End Date (DD/MM/YYYY)

The Vision

What does your project want to achieve? What specific problem do you wish to address?

Please provide information on the context as well as any data (e.g. statistics, reports, case studies, stories of people with lived experience) which may support our understanding.

The Project

How will you deliver the project?

Please give details about how the project will work. If possible, please give a step-by-step account.

What is the inspiration behind the project idea and how was the project designed?

How is your project different from what has been tried before?

The Team

Who are the people that will solve the problem, what is their experience, knowledge and expertise in this area?

What networks and relationships do you have? How will you create new networks? How will you use these networks to achieve your goal?

The Impact

How will the world be different when the project is over? What data will you collect to show the difference you have made? How will you share and build on the learning from the project?

How will your idea benefit Black people with long term conditions? How could your proposed solution create long term change?

Is there anything else you would like to add to support your application?

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FINANCIAL DETAILS

How much are you applying for?

Project Budget Document - please attach a breakdown of all project related expenditure and income

BANK DETAILS

Payee Name (e.g. Mr John Smith)

Length of Payee Name should be 18 characters max

Bank Account Number

Bank Sort Code

Bank Name (e.g. Barclays)

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REFERENCES

We would like to speak to two representatives of your partner organisations (at least one should be connected to Lambeth). By providing their names and contact details below we will assume that you will have alerted them to the possibility of our contact. Please be aware that we may undertake other conversations about your organisation or proposed project/service with individuals that we believe have relevant knowledge or expertise (e.g. experts in the field, other funders, various Foundation contacts or advisers).

Referee 1

Name of organisation

How have your worked together?

Time period (specific dates)

Title

First Name

Surname

Address

Email address

Telephone Number

Referee 2

Name of organisation

How have your worked together?

Time period (specific dates)

Title

First Name

Surname

Address

Email address

Telephone Number

DOCUMENTATION AND DECLARATION (page 5 of 5)

This grant programme is a partnership between Black Thrive, Guy's and St Thomas' Charity and Walcot Foundation. Walcot Foundation is providing administrative support for the grant programme but assessments and decisions are made by the Black Thrive Employment Working Group.

Under General Data Protection Regulations (GDPR), your email address is considered personal data. Are you willing to give consent to the following (all are optional)

Black Thrive to share your contact details with other applicants/grantees of the grant programme for the purpose of networking and sharing ideas.Black Thrive to share Black Thrive non-grant related information with you (e.g. details on upcoming events, useful community resources)Walcot Foundation to share Walcot related non-grant information with you (e.g. Walcot e-newsletter, details on training etc)

Please attach relevant documentation below. If there are problems with attachments, you can send the documents to Walcot Foundation, 127 Kennington Road, London SE11 6SF or email to grants@walcotfoundation.org.uk. Please note that the maximum size of each file is 5MB.

CV

Constitution or Governing Document

Current Organisational Diagram

Latest Annual Report/Accounts (only necessary if not on Charity Commission website)

Safeguarding Policy (if working with children or vulnerable adults)

Current Income and Expenditure budget for ENTIRE organisation

Job Descriptions for relevant posts (i.e. those which this grant would fund or part-fund)

Recent bank statement

DECLARATION

By clicking SUBMIT below:

I certify that the information I have given in this application is complete and correct, and have verified the need for all items requested. (Please note that a decision will be based on the information given on this form. If a grant is awarded and the information is subsequently found to be incorrect, any grant that had been awarded could be withdrawn and you could be asked to repay any monies already paid).
My organisation has no objection to the data contained in this application being held by Black Thrive, Walcot Foundation and Guy's and St Thomas' Charity.
My organisation has no objection to Black Thrive and Walcot Foundation discussing this application with any of the referees named by your organisation in the course of the assessment process and other appropriate organisations and individuals.
To help Black Thrive, Walcot Foundation and Guy's and St Thomas' Charity monitor and evaluate its work, I agree I may be contacted in the future whether or not this application is successful. This would be to obtain feedback on the programme’s work and to see if there are other ways the organisations could be of assistance.

PLEASE NOTE - when you click 'Submit', you will get a preview of your completed form which you can print and review before you finally submit. Also after submission, you will get an email copy of your application form.