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|Volunteer Centre Organisation Registration Form (VC Connect) |[pic] |

Section A - Organisation Registration (complete if registering for the first time)

*Organisation Name:

*Postcode:

*Organisation Type (Please select one):

| |Non-voluntary | |Statutory |

| |Private | |Voluntary |

Building:

Building / House No:

*Street:

District:

*Town:

County:

Main contact name for volunteers:

Contact telephone number for volunteers:

Fax number:

Main contact email for volunteers:

Website link:

Department / Branch:

Opening Hours:

Twitter link:

Facebook link:

|*Organisation Aims & Activities: |

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Services provided by your Organisation:

Please tick a MAXIMUM of ONE service per column.

One primary service (*P) MUST be ticked and up to three other optional services.

| |*P |1 |2 |3 |

|Accommodation | | | | |

|Advice / Information services | | | | |

|Advocacy | | | | |

|Animal welfare | | | | |

|Arts & media | | | | |

|Befriending | | | | |

|Business support | | | | |

|Campaigning | | | | |

|Careers services | | | | |

|Community Development | | | | |

|Community services / Facilities | | | | |

|Counselling & Therapy services | | | | |

|Crime / Community Safety | | | | |

|Day care services | | | | |

|Disability | | | | |

|Domestic Abuse / Sexual Abuse | | | | |

|Education / Children (Pre school / After school) | | | | |

|Education / Training | | | | |

|Employment | | | | |

|Environment / Conservation | | | | |

|Faith / Religion | | | | |

|Family services | | | | |

|Financial services | | | | |

|Funding & grants | | | | |

|Health – general | | | | |

|Homelessness | | | | |

|Housing | | | | |

|International aid | | | | |

|Low income | | | | |

|Lunch clubs | | | | |

|Mediation | | | | |

|Mental health | | | | |

|Mentoring | | | | |

|Out of school provision | | | | |

|Poverty / Low income | | | | |

|Regeneration | | | | |

|Sexual health | | | | |

|Social activities | | | | |

|Social and community care services | | | | |

|Sport and leisure | | | | |

|Substance misuse | | | | |

|Telephone helpline | | | | |

|Tenants and residents | | | | |

|Translation / Interpreting | | | | |

|Transport | | | | |

|Voluntary & community sector support | | | | |

|Volunteering | | | | |

|Women’s issues | | | | |

|Youth clubs / services | | | | |

Client Groups specifically served by your Organisation:

Please tick a MAXIMUM of ONE service per column OR “ALL CLIENT GROUPS”.

One primary service (*P) MUST be ticked and up to three other optional services.

| |*P |2 |3 |4 |

|ALL CLIENT GROUPS | | | | |

|Asian (All) | | | | |

|Asian (Burmese) | | | | |

|Black African | | | | |

|Black African – Caribbean | | | | |

|Black & Ethnic Minority (All) | | | | |

|Black British | | | | |

|Carers | | | | |

|Children | | | | |

|Disabled People (All) | | | | |

|Employed | | | | |

|Faith Groups | | | | |

|Families / Parents | | | | |

|Gay / Lesbian / Bisexual / Transgender | | | | |

|Homeless People | | | | |

|Housing Support Services (People Receiving) | | | | |

|Indian | | | | |

|Irish | | | | |

|Learning Disabilities (People With) | | | | |

|Lone Parents | | | | |

|Long Term / Chronic Illness (people With) | | | | |

|Low Income | | | | |

|Men | | | | |

|Mental Health Problems (People With) | | | | |

|Offenders / Ex-offenders | | | | |

|Older People | | | | |

|Pakistani | | | | |

|Physical / Sensory Impairments (People With) | | | | |

|Refugees / Asylum Seekers | | | | |

|Social Entrepreneurs | | | | |

|Somali | | | | |

|Substance Misuse | | | | |

|Survival of Abuse / Victim of Crime | | | | |

|Tenant and Resident | | | | |

|Travellers | | | | |

|Unemployed | | | | |

|Voluntary & Community Groups | | | | |

|Volunteers | | | | |

|Women | | | | |

|Yemeni | | | | |

|Young People | | | | |

Areas served by your Organisation:

(Please select “SEFTON WIDE” or specific areas within Sefton)

(Please select any other local surrounding areas of Sefton served by your Organisation)

|Sefton Wide | | |Burscough | |

|Ainsdale | | |Liverpool | |

|Aintree | | |Ormskirk | |

|Birkdale | | |West Lancashire | |

|Bootle | | |Wirral | |

|Crosby | | |

|Formby | | |

|Hightown | | |

|Litherland | | |

|Lydiate | | |

|Maghull | | |

|Melling | | |

|Netherton | | |

|Seaforth | | |

|Southport | | |

|Thornton | | |

|Waterloo | | |

Income Bracket:

(Please select annual income for your Organisation)

|Under £1,000 | |£250,000 - £499,999 | |

|£1,000 - £9,999 | |£500,000 - £1,000,000 | |

|£10,000 - £49,999 | |Over £1,000,000 | |

|£50,000 - £99,999 | |Unknown | |

|£100,000 - £249,999 | | | |

Structure:

(Please select your Organisation’s structure type)

|Branch of National Voluntary Organisation | |

|Community Group | |

|Faith Group | |

|Other | |

|Social Enterprise | |

|Community Forum / Development Trust | |

|Company Limited By Guarantee | |

|Local Voluntary Organisation | |

|Self Help Group | |

|Unknown | |

Number OF Full Time Employees:

|NONE | |21 to 50 | |

|1 to 5 | |Over 50 | |

|6 to 10 | |Unknown | |

|11 to 20 | | | |

If you have a logo, please provide an electronic copy with this application

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