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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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