APPLICATION FORM

Delivery Partner Status

This application form is for those applicants wishing to apply for Approval as a GoldMark Delivery Partner in Northern Ireland.

Please read “The Guide” before completing this application form.

Please fill in the application form by typing or printing in black ink and please answer each question in the space provided. Please do not send additional brochures or leaflets apart from the documents requested.

Information about your Organisation

Name of organisation: ______

Address: ______

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Postcode: ______

Tel: ______

Fax: ______

Email:______

Name & position of contact for the application process:

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______

1.1 Type of organisation

Charity recognised by the Inland Revenue Number ______

Unincorporated club or association

Company limited by guarantee

Friendly society or Industrial & Provident

Charitable Trust

Public Body

Other (please specify)______

1.2Aims of your organisation (in point form if possible)

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1.3Main activities of your organisation (in point form if possible)

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1.4What experience does the organisation have of working with young

people?

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1.5What experience does the organisation have of the recruitment, support

and development of volunteers?

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1.6Which geographical area of Northern Ireland does your organisation cover?

Please tick all that are relevant

Council Area / Please Tick
All of Northern Ireland
Antrim
Ards
Armagh
Ballymena
Ballymoney
Banbridge
Belfast
Carrickfergus
Castlereagh
Coleraine
Cookstown
Craigavon
Derry
Down
Dungannon
Fermanagh
Larne
Limavady
Lisburn
Magherafelt
Moyle
Newry & Mourne
Newtownabbey
North Down
Omagh
Strabane

1.7Which of the areas noted in 1.6 will GoldMark cover?

All

A selection (please specify) ______

1.8Do you intend to target any specific group(s) of young people to participate? (e.g. young people from ethnic minority groups etc)

Yes  No If yes, please specify ______

1.9Does your organisation currently deliver any other volunteering /

citizenship programmes for under 25 yr olds?

(e.g. Princes Trust Volunteers, Youth Achievement Awards, Duke of Edinburgh Award Scheme, Young Ambassadors)

Yes  No If yes, please specify ______

1.10What type and number of volunteer opportunities do you currently offer

which are suitable for young volunteers?

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1.11 Total number of current volunteers (including trustees) ______

Number of volunteers under 25 ______

1.12 Number of paid staff

Full-time______

Part-time______

Quality Assurance Undertakings

2.1Delivery Partners must ensure that volunteers will be safe and treated fairly whether they are placed within the organisation or with a third party in the community. (Please see The Guide).

Please confirm the following:

Volunteer opportunities will comply with Health and Safety requirements. A copy of our Health and Safety policy and associated procedures is enclosed. (Organisations with fewer than 5 employees should enclose a written statement of commitment to ensuring the Health & Safety of GoldMark Volunteers).

Yes  No 

The organisation has a positive commitment to equal opportunities. A copy of our written equal opportunities policy, which takes account of relevant aspects of current legislation, is enclosed along with associated procedures.

Yes  No 

The organisation has adequate public & employers’ liability insurance that clearly covers volunteers and staff supporting them. Details of relevant policies are enclosed.

Yes  No 

The organisation will implement the good practice outlined in “Our Duty to Care” in relation to volunteers working with children or vulnerable adults and for those involving volunteers under the age of 18 or vulnerable adults. A copy of our child protection policy and associated procedures is enclosed. (Copies of the Our Duty to Care Guidelines are available from Volunteer Now).

Yes  No 

The organisation will ensure that Volunteers will not substitute for paid jobs or devalue the contribution of existing volunteers.

Yes  No 

Personal information provided by young people will be treated sensitively and confidentially.

Yes  No 

Volunteers who wish to, will be referred to third party placements or to other registered Delivery Partners who will offer them a range of alternative options. The Delivery Partner will take responsibility for ensuring that any participating third party organisation will comply with all aspects of the quality assurance undertakings.

Yes  No 

The participation of the young people is entirely voluntary.

Yes  No 

The organisation agrees to participate in the overall monitoring and evaluation of the Programme as directed by Volunteer Now.

Yes  No 

Volunteer Now will accept applications from organisations that have not yet developed all the aforementioned policies and procedures providing there is a written commitment to doing so included with the application form. The statement of commitment should be signed by an office bearer, and should identify realistic timeframes.

Details of how you will involve Volunteers in your programme.

3.1Please provide a brief description of how you will involve Volunteers

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Reference and Declaration

4.1 Please give us the contact details of someone who can tell us more about

your organisation and its work in relation to young people. This individual

should be independent of your organisation e.g. not a member, beneficiary or trustee.

Please ask their permission before you give us their details.

Name:
Address:
Phone:
Fax:
E-mail:

4.6 On behalf of the organisation we confirm that the information in this application is correct and, if approved, all requirements of the Programme will be fully complied with.

Signed: / Signed:
Name: / Name:
Position: / Position:
Date: / Date:

At least one of the two signatories must be an office-bearer on the organisation’s management committee.

Please see overleaf for checklist of enclosures.

Checklist

Please ensure that you enclose the following:

 A list of current committee members/trustees/directors

 A copy of the organisation’s equal opportunities policy and procedures

 A copy of the organisation’s health and safety policies and procedures

 A copy of the organisation’s child protection policy and procedures

 A copy of the organisation’s volunteer policy

 Copies of relevant insurance cover documents

NB: Applicants who have accessed the form by e-mail should submit a signed

printout of the application form and be extremely careful to ensure that all

pages have been included.

STOP

Before you submit your application please make sure you have

answered all the questions and included all the information requested.

Completed applications to be returned to:

Volunteer Now, 129 Ormeau Road, Belfast, BT7 1SH