Time to Change Hubs Application Form 2016/17

Time to Change Hubs Application Form 2016/17

Completing and returning the form
Your application may be completed by any one of your potential Time to Change Hub’s core partner organisations. However, if you are selected as a Time to Change Hub we will require all listed partner leads to sign a partnership agreement with each other and Time to Change.
Please read the Time to Change Hubs Application Guidance Notes before completing this form
Please fill in this form electronically or clearly in BLACK ink
Every section of the form must be completed for your application to be considered
Please expand boxes or add rows as necessary
If you have any questions please contact
Completed applications should be returned to with the subject header ‘TTC Hub application: [Your Area Name]’, or by post to:
Steve Bonner
Time to Change (C/O Mind)
15-19 Broadway
Stratford
London E15 4BQ
The finalised form must be received by us no later than 5pm on Friday 2 December 2016.
It is your responsibility to make sure that your application form reaches Time to Change. Time to Change cannot accept responsibility for forms that are lost in the post or which do not arrive by email.
A. Your commitment to mental health and anti-stigma and discrimination work
1. Mental health in your local strategies
a) What are the priority areas for your Health and Wellbeing Strategy in relation to mental health?
b) What period does your Health and Wellbeing Strategy cover?
c) How will hosting a Time to Change Hub help you to meet related outcomes in your Health and Wellbeing Strategy?
d) Please attach, or include a link to, your Health and Wellbeing Strategy.
e) What other local strategies would a Time to Change Hub contribute to and how?
2. Your support for and commitment to a Time to Change Hub
a) Hub Host details.
Please provide details of your nominated Time to Change Hub Host organisation, including the senior-level individual who will have ultimate responsibility for your Time to Change Hub.
Name of organisation / body
Type of organisation / body
Website
Name of senior-level staff
Job title and Department
E-mail address
Phone number
Rationale for nomination
b) Local Authority details.
Please provide details of your Local Authority who is supporting the Hub proposal, including the senior-level individual who will have lead responsibility for the Hub within the Local Authority. (If the Local Authority is your nominated Hub Host leave this section blank)
Name of Local Authority
Type of Local Authority
Website
Name of senior-level staff
Job title and Department
E-mail address
Phone number
c) Hub Coordinator
Please provide details of your nominated Time to Change Hub Coordinator organisation, including a senior-level individual who is able to endorse this organisation’s commitment.
Name of organisation
Type of organisation
Website
Name of senior-level staff
Job title and Department
E-mail address
Phone number
Rationale for nomination
i. Please tell us about your Time to Change Hub Co-ordinator’s experience of administering funding to individuals and how they will apply their experience to the administration of the Time to Change Champions Fund.
d) Wider Hub partners
Please provide details of any other key organisations you have already engaged as part of the application process to work within your Time to Change Hub.
Partner 1
Name of organisation
Type of organisation
Website
How will they contribute to the Hub?
Organisation website
Contact name
Contact details
Partner 2
Name of organisation
Type of organisation
Website
How will they contribute to the Hub?
Organisation website
Contact name
Contact details
Partner 3
Name of organisation
Type of organisation
Website
How will they contribute to the Hub?
Organisation website
Contact name
Contact details
Partner 4
Name of organisation
Type of organisation
Website
How will they contribute to the Hub?
Organisation website
Contact name
Contact details
B. Your proposal
1. Your local area
Please provide details about the area which your Time to Change Hub will operate within
a) Area covered by the Hub
b) Approximate population of Hub area
c) Population by ethnicity (% or #)
British (White) / Indian (Asian/Asian British)
Irish (White) / Pakistani (Asian/Asian British)
Gypsy or Irish Traveller (White) / Bangladeshi (Asian/Asian British)
Other White / Chinese (Asian/Asian British)
White and Black Caribbean (Mixed) / Other Asian
White and Black African (Mixed) / African (Black/Black British)
White and Asian (Mixed) / Caribbean (Black/Black British)
Other mixed/multiple ethnic / Other Black/ African/ Caribbean
Other ethnicity / Arab
d) Source of above data
e) Other relevant demographic information
2. Your Time to Change Hub’s activities
Please give an indication of the types of activities your Time to Change Hub will deliver and what you anticipate these activities will involve.
a) Tell us why you have chosen to apply to host a TTC Hub, and why this activity is important to you and your local population.
What would you like to do with your local campaign?
b) What events might your Hub deliver?
c) What media activity might your Hub deliver?
d) What online activity might your Hub deliver?
e) Please describe how you would ensure marginalised or disadvantaged groups were engaged by the Hub
C. Your capacity to run a Time to Change Hub
1. Management of the Time to Change Hub
a) Please describe the experience any of your proposed Hub partners have of running similar public facing campaigns in the past.
b) How will you embed leadership of people with experience of mental health problems in each of the following key aspects of your Time to Change Hub?
Governance
Activity planning
Activity delivery

c) Please give details of any staffing arrangements you already have in place for the administration of your Time to Change Hub, or any arrangements you plan to make should your application be successful.
Organisation / Name and job title of staff member / Anticipated responsibilities within the Hub / Time available for Hub work

2. Risk Register
Please identify the main risks you foresee regarding your Time to Change Hub, and how you will manage them
Risk / (1 low - 5 high) / Mitigation
Impact
(1-5) / Likelihood (1-5) / Total score
(I x L)

D. Sustaining your Time to Change Hub
a) Please explain how you plan to maximise the impact of your Hub and ensure that there is a legacy for your Time to Change Hub activity.
b) If there is anything else you wish us to consider as part of your application which is not covered elsewhere, please let us know here

E. Signature
The individual completing this application must sign this application on behalf of the organisation they work for. If you are selected as a Time to Change Hub we will require all listed partner leads to sign a partnership agreement.
Organisation / Name / Job title / Signature / Date
Hub Host
Hub Coordinator
Local Authority
Next steps
An impartial Shortlisting Panel will aim to review all applications and shortlist proposals for interviews with our Decision Panel by Friday 12 December 2016.
There will then be a two week window during which the Shortlisting Panel may request clarification from applicants around any aspect of their application ahead of the Decision Panel meeting
We expect that interviews with the Decision Panel will take place between 2nd – 13th January 2017. Interviews can be conducted remotely via Skype if required. As a minimum we would expect the following to attend the interview;
A representative of the organisation leading the application, and
A senior representative from the Local Authority, Health & Wellbeing Board or Local Councillor
Final decisions will be communicated with all applicants, and made public on the Time to Change website w/c 16 January 2017. The ‘6 month start up’ period will begin at a ‘Time to Change Hub kick off meeting’ with core partners, expected to be between 23 January and 20 February 2017. Successful applicants will then begin work with Time to Change staff to develop a robust activity plan, and Hub Partnership Agreements are expected to be signed by Monday 6 March 2017.