Apply now: Wigan Social Innovators in Health and Wellbeing Programme The School for Social Entrepreneurs

SECTION A - YOUR PERSONAL DETAILS

First Name(s)*

Preferred Name if different from above

Last Name(s)*

First line of home address*

Town/City of your home address*

Postcode*

Your preferred phone number for contact regarding this application*

Email address*

Date of Birth*

Accessibility - We want our programme to be as accessible as possible. Please let us know if you have a disability, caring responsibilities, or anything else that might affect your ability to attend the interview or to participate in an SSE programme.

If you feel you would require reasonable adjustments in order to participate please include details below. Please select 'Yes' or 'No'*

YES
NO

SECTION B - ELIGIBILITY CRITERIA

I am a resident and eligible to work in the UK*

YES
NO

If successful in this application, I am committed to developing my project and attending the full programme, which is a commitment of 14 days*

YES
No

My project facilitates/supports/enables cycling and walking to address health and wellbeing inequalities in Wigan*

YES
No

I confirm that this project is in the planning stages but ready to start OR is less than two years old with income of ideally less than £50,000 per year.*

YES
No

If my project is working with children or vulnerable adults, I understand that I will need to provide an up to date criminal records disclosure*

YES
No

My project will reinvest the majority of any surplus into the project, or for a social or environmental purpose*

YES
No

If my project winds up or closes, any remaining money or assets will be redistributed for social or environmental purposes – not to individuals*

YES
No

You must be able to answer NO to the following:*

Are you currently declared bankrupt, or under a Debt Relief Order?

YES
NO

*

Are you barred from acting as a company director or charity trustee?

YES
NO

*

Do you have an unspent conviction for fraud?

YES
NO

CONNECTION TO SSE*

Have you or anyone else from your project previously applied to The School for Social Entrepreneurs?

YES
NO

If YES,please provide details of the programme(s) attended or applied for, otherwise write 'n/a'*

Are you connected (financially or by family) to anyone who is employed by or is a director of SSE or Wigan Council?*

YES
NO

SECTION C - ABOUT YOU

Please tell us why you want to develop this project?*

(Maximum 500 words)• - What are your main reasons for setting up or being involved in this project? - What motivates you? - What led you to this point? - Do you have any experience of the issues you are seeking to address? Anything else you'd like to add?

What do you hope to get out of the Programme?*

(Maximum 300 words)

SECTION D - ABOUT YOUR PROJECT

Name of your project*

Please put 'N/A' if not yet named

Website address for your project (if you have one)

Facebook page for your project (if you have one)

Instagram account of your project (if you have one)

Twitter handle of your project (if you have one)

Is your project hosted by a larger organisation? If so, please give details. Otherwise please type in 'N/A'*

Have you already set up as an project/organisation?*

YES
NO

If YES, what is your current legal structure?

Sole Trader
Company Limited by Guarantee
Community Interest Company (CIC)
Charity (registered or non registered
Other*

* If 'Other' - please describe below:

What date was your project established/registered?*

Please upload or email us your governing documents (for example, your Constitution or Articles) when you submit your application at the end of this form.

Will your project work with under 18's or vulnerable adults?*

YES
NO

Where is, or where will be, the base for your project? And where does it, or where will it, deliver its services?

What is the main impact area of your project?*

Who are your main beneficiaries – e.g. young people or children with disabilities?*

* If 'Other', please describe below:

Please tell us a bit more about your project.*

In this section we are interest to know: - What are the needs and issues you are addressing? - What will your project do? - What activities will be available? - How does/will it make a differerence? - Who are your main beneficiaries and how many? - Who else is involved in the project as staff/volunteers etc? - What research have you done? - Pilot projects/trails? - Anything else you want to tell us?

SECTION E - YOUR PROJECT'S FINANCES

What was your project's £ income in the LAST year, if any?

Please include grants or other funding, trading, sponsorship, loans. Please put N/A if you are not yet trading.

What income, if any, have you had in the last TWO years?

Including grants or other funding, trading, sponsorship, loans. If none, please state.

Do you have any annual accounts for the last year?*

YES
NO

If YES, please upload them at the end of this application. If you don't have these, you are still eligible to apply.

What are your plans to make your project financially sustainable in the next few years?*

For example, will you sell products or services, will you apply for grants, seek donations or other? Have you had any funds committed yet?

• Have you answered all the questions on the form? • Have you checked that you meet all of the eligibility criteria? • Have you uploaded your governing document below, if you have one? • Have you uploaded your accounts, if you have them? Please upload any documents below. Please note each upload button will allow for one file only- uploading more than one will override previous uploads. Please save all documents to show your name, to your own device and keep for your own records, for example, “FirstnameSurnameAccounts.doc”. If you have any problems or wish to send us anything additional at a later date, please email [email protected]

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Apply now: Wigan Social Innovators in Health and Wellbeing Programme

Important information for applicants

Top tips for applying

SECTION A - YOUR PERSONAL DETAILS

SECTION B - ELIGIBILITY CRITERIA

SECTION C - ABOUT YOU

SECTION D - ABOUT YOUR PROJECT

SECTION E - YOUR PROJECT'S FINANCES

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